Organ preservation and oncological efficacy of peniscopically controlled CO2 laser excision of penile squamous cell carcinoma: Early and late results in a high-volume center

Objectives: To evaluate safety and early and long-term efficacy of CO2 laser conservative treatments for nonulcerative squamous cell carcinoma (SCC) of the penis. Material and Methods: Within our institutional database (2002–2022, included), we identified 122 consecutive cT1-2 cN0 cM0 patients with penile SCC who underwent conservative CO2 laser treatments. Histologically confirmed local relapses were recorded. Local relapses were classified as early recurrences when occurring <2 years and as late new tumor recurrences when occurring >2 years after first laser treatment. Predictors of disease relapse were analyzed with univariable and multivariable Cox regression models (MCRMs). Results: Median follow-up was 36 months [Interquartile range (IQR) 21-73 months]. Median age was 62 years (IQR: 51-69 years). Median largest lesion size was 10 mm (IQR 5-15 mm). 62 patients had penile intraepithelial neoplasia (PeIN) (51.6%), 30 had pT1 m (24.6%), 28 had pT1 (23%) and 1 had pT2 (0.8%), 2 patients were classified as pTx. In case of invasive lesions, tumor Grade was G1 in 37 (60.7%), G2 in 20 (32.8%), G3 in 4 (6.5%). Early and late recurrences occurred in 28 (22%) and in 21 patients (18%), respectively. Proportion of penis preservation was 93.4% and 92.6% at 2 and 5 years. pT1 stage [Hazard Ratio (HR) 13, Confidence Interval (CI) 1.4-73, p-value 0.02] and flat lesions (HR 7.9, CI 1.06-59, 0.04) achieved independent predictor status for late recurrences. No cancer related deaths were recorded after a median follow-up of 36 months. Conclusions: As far as we know, this is the largest cohort of patients with penile cT1-T2 SCC who underwent conservative CO2 laser treatment. The vast majority (92%) of these patients preserved their organ at 5 years. Some factors can be of use in preventing or anticipating late recurrences.