Penile Cancer Peniscopically Controlled CO 2 Laser Excision for Conservative Treatment of In Situ and T1 Penile Carcinoma: Report on 224 Patients Gaetano Bandieramonte a , Maurizio Colecchia b , Luigi Mariani c, *, Salvatore Lo Vullo c , Giorgio Pizzocaro d , Luigi Piva d , Nicola Nicolai d , Roberto Salvioni d , Valentina Lezzi e , Bernardina Stefanon e , Giuseppe De Palo e a Department of Surgery, Day Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy b Department of Pathology and Cytopathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy c Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy d Department of Surgery, Unit of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy e Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy european urology 54 (2008) 875–884 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted January 4, 2008 Published online ahead of print on January 15, 2008 Keywords: Adjuvant chemotherapy Carcinoma Laser surgery Penis Peniscopy Abstract Objective: To evaluate the outcome of peniscopically controlled laser excision of early-stage penile carcinoma. Methods: Patients treated from 1982 to 2006 were investigated. The primary treatment was excisional surgery alone for in situ or initially invasive flat tumors, and reductive chemotherapy followed by surgery for the exophytic lesions. All excisional procedures were conducted by CO 2 laser under peniscopic control. Results: Of a total of 224 patients, 111 underwent partial excision of the glans and/ or coronal sulcus surface, and 113 total surface excision. Forty patients under- went reductive chemotherapy. Complete excision was obtained in 221 cases (98.7%) at lateral margins and in 217 cases (96.9%) at deep margin. Postoperative complications were negligible. Overall, the 10-yr recurrence rate was 17.5% (95% confidence interval, 16.4–18.6%), and apparently was not affected by the in situ or invasive nature of the lesion. Amputation was required in nine patients, for a 10-yr amputation rate of 5.5% (range, 5.2–5.7%). In the remaining cases, organ form and curvature were preserved, with satisfactory cosmetic and func- tional results. Conclusions: Early-stage penile carcinomas can be effectively treated with the organ-sparing strategy described here. Because local recurrences occur in a min- ority of patients and can be safely treated, organ preservation is compatible with local disease control. Reductive systemic chemotherapy in selected exophytic cases broadens the indication for our conservative approach. # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Fondazione IRCCS Istituto Nazionale Tumori, Unit of Medical Statistics and Biometry, Via G. Venezian 1, 20133 Milan, Italy. Tel. +39 02 23903199; Fax: +39 02 23902095. E-mail address: luigi.mariani@istitutotumori.mi.it (L. Mariani). 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2008.01.019