Abstract：
BACKGROUND: Penile shaft sparing (PSS) surgery for localised penile cancer (PeCa) aims to balance oncological and functional outcomes.
OBJECTIVE: To summarise the published evidence on different PSS approaches.
METHODS: We performed a systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The systematic search was performed on PubMed, EMBASE, and Scopus databases up to February 14, 2023. The inclusion criteria encompassed retrospective or prospective studies including patients ≥18 yr of age with localised PeCa treated with different PSS approaches, classified as laser ablation, circumcision, wide local excision, glansectomy with or without split skin graft, glans resurfacing, and mixed technique excision. The risk of bias was assessed using the Newcastle-Ottawa scale. A quantitative synthesis was not performed due to anticipated data heterogeneity and a lack of comparative studies.
RESULTS: Out of 4343 articles identified, 47 met our inclusion criteria, including 10 847 patients. The year of publication ranged between 1983 and 2021. Nine studies were prospective case series, while the remaining studies were retrospective. No comparative studies were identified. Most of the cases included in these studies were Ta and T1. The oncological outcomes were good for all the approaches, with cancer-specific mortality ranging between 0% and 18%. Sexual and cosmetic outcomes, despite being under-reported, were good for all the approaches, with almost all patients being satisfied with their quality of life after surgery. The Newcastle and Ottawa scale revealed a high or severely high risk of bias in all the included studies.
CONCLUSIONS: PSS approaches were safe and had good functional outcomes, considering however the overall low quality of the studies on this issue.
RESULTS: The perioperative, function, and oncological outcomes of penile shaft sparing approaches are good. However, high-quality studies are needed to determine whether these approaches benefit patients with localised penile cancer.
OBJECTIVE: To summarise the published evidence on different PSS approaches.
METHODS: We performed a systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The systematic search was performed on PubMed, EMBASE, and Scopus databases up to February 14, 2023. The inclusion criteria encompassed retrospective or prospective studies including patients ≥18 yr of age with localised PeCa treated with different PSS approaches, classified as laser ablation, circumcision, wide local excision, glansectomy with or without split skin graft, glans resurfacing, and mixed technique excision. The risk of bias was assessed using the Newcastle-Ottawa scale. A quantitative synthesis was not performed due to anticipated data heterogeneity and a lack of comparative studies.
RESULTS: Out of 4343 articles identified, 47 met our inclusion criteria, including 10 847 patients. The year of publication ranged between 1983 and 2021. Nine studies were prospective case series, while the remaining studies were retrospective. No comparative studies were identified. Most of the cases included in these studies were Ta and T1. The oncological outcomes were good for all the approaches, with cancer-specific mortality ranging between 0% and 18%. Sexual and cosmetic outcomes, despite being under-reported, were good for all the approaches, with almost all patients being satisfied with their quality of life after surgery. The Newcastle and Ottawa scale revealed a high or severely high risk of bias in all the included studies.
CONCLUSIONS: PSS approaches were safe and had good functional outcomes, considering however the overall low quality of the studies on this issue.
RESULTS: The perioperative, function, and oncological outcomes of penile shaft sparing approaches are good. However, high-quality studies are needed to determine whether these approaches benefit patients with localised penile cancer.
摘要：
背景：保留阴茎干（PSS）手术治疗局部阴茎癌（PeCa）旨在平衡肿瘤和功能结果。
目的：总结已发表的关于不同PSS方法的证据。
方法：我们根据系统评价和Meta分析指南的首选报告项目进行了系统评价。系统搜索是在PubMed上进行的，EMBASE,和截至2023年2月14日的Scopus数据库。纳入标准包括回顾性或前瞻性研究，包括年龄≥18岁的患者采用不同PSS方法治疗的局部PeCa。归类为激光烧蚀，包皮环切术,广泛的局部切除，有或没有裂开皮肤移植物的腺体切除术，龟头重新浮出水面，和混合技术切除。使用纽卡斯尔-渥太华量表评估偏倚风险。由于预期的数据异质性和缺乏比较研究，没有进行定量综合。
结果：在确定的4343篇文章中，47符合我们的纳入标准，包括10847名患者。出版年份为1983年至2021年。九项研究是前瞻性病例系列，其余研究为回顾性研究.没有发现比较研究。这些研究中包括的大多数病例是Ta和T1。肿瘤学结果对所有方法都很好，癌症特异性死亡率在0%到18%之间。性和美容结果，尽管被低估了，对所有的方法都有好处，几乎所有患者都对手术后的生活质量感到满意。纽卡斯尔和渥太华量表在所有纳入的研究中都显示出高度或严重的偏倚风险。
结论：PSS方法是安全的，并且具有良好的功能结果，然而，考虑到这个问题的研究总体质量较低。
结果：围手术期，函数,阴茎轴保留方法的肿瘤学结果良好。然而,需要高质量的研究来确定这些方法是否有利于局部阴茎癌患者.
目的：总结已发表的关于不同PSS方法的证据。
方法：我们根据系统评价和Meta分析指南的首选报告项目进行了系统评价。系统搜索是在PubMed上进行的，EMBASE,和截至2023年2月14日的Scopus数据库。纳入标准包括回顾性或前瞻性研究，包括年龄≥18岁的患者采用不同PSS方法治疗的局部PeCa。归类为激光烧蚀，包皮环切术,广泛的局部切除，有或没有裂开皮肤移植物的腺体切除术，龟头重新浮出水面，和混合技术切除。使用纽卡斯尔-渥太华量表评估偏倚风险。由于预期的数据异质性和缺乏比较研究，没有进行定量综合。
结果：在确定的4343篇文章中，47符合我们的纳入标准，包括10847名患者。出版年份为1983年至2021年。九项研究是前瞻性病例系列，其余研究为回顾性研究.没有发现比较研究。这些研究中包括的大多数病例是Ta和T1。肿瘤学结果对所有方法都很好，癌症特异性死亡率在0%到18%之间。性和美容结果，尽管被低估了，对所有的方法都有好处，几乎所有患者都对手术后的生活质量感到满意。纽卡斯尔和渥太华量表在所有纳入的研究中都显示出高度或严重的偏倚风险。
结论：PSS方法是安全的，并且具有良好的功能结果，然而，考虑到这个问题的研究总体质量较低。
结果：围手术期，函数,阴茎轴保留方法的肿瘤学结果良好。然而,需要高质量的研究来确定这些方法是否有利于局部阴茎癌患者.
