Abstract

Background/Objectives: Optimal surgical margin management in penile squamous cell carcinoma remains debated because organ-preserving surgery must balance oncological control with functional preservation. Historically, wide excision margins have been recommended; however, subsequent evidence has challenged this threshold, shifting practice towards narrower margins without a demonstrated increase in local recurrence. We evaluated whether invasive positive surgical margins and minimal negative margin widths were associated with local recurrence and survival after surgery for penile squamous cell carcinoma. Methods: We retrospectively analysed 157 consecutive men who underwent surgical treatment at a single centre between 2011 and 2024. Time-to-event analyses were performed in 131 patients with invasive non-metastatic disease after excluding those with penile intraepithelial neoplasia (PeIN)-only lesions (n = 23) and distant metastases (n = 3) at diagnosis. The margins were classified as either invasive-negative or invasive-positive. Among histologically negative-margin cases, minimal margin width was grouped a priori as <2 mm, 2–5 mm, and >5 mm. Results: The median follow-up was 25 months (interquartile range [IQR], 10–52). In the invasive (M0) cohort, 101/131 patients had invasive-negative margins and 30/131 had invasive-positive margins; local recurrence occurred in 42/131 patients. Margin status was not independently associated with recurrence-free, overall, or cancer-specific survival rates. Non-sparing surgery was associated with a lower hazard of local recurrence, whereas grade 3 (G3) histology independently predicted worse recurrence-free, overall, and cancer-specific survival. Advanced stage according to the Tumour, Node, Metastasis (TNM) classification independently predicted worse cancer-specific survival. Conclusions: Among patients with histologically negative margins, outcomes did not differ significantly across the predefined margin-width categories. These findings support tissue-preserving surgery aimed at histologically negative margins within a structured surveillance framework.

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