Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study

Keske, Murat; Canda, Abdullah Erdem; Yalçın, Serdar; Kılıçarslan, Aydan; Kïbar, Yusuf; Tuygun, Can; Önder, Evrim; Atmaca, Ali Fuat; Yıldırım, Asıf; Özkanli, Sıdıka Şeyma; Kandemir, Olcay; Kargı, Taner; Sar, Mehmet; Tuğcu, Volkan; Reşorlu, Berkan; Aslan, Yılmaz; Sarıkaya, Selçuk; Boylu, Uğur; Çiçek, Ali Fuat; Başar, Halil; Tuncel, Altuğ; Balbay, Mevlana Derya

doi:10.5489/cuaj.4016

Cited by 13 publications

(13 citation statements)

References 13 publications

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“…Most of these lesions were benign at final diagnosis, while the incidence of malignant lesions <10 mm in diameter was low. The present study supports and confirms results of previous studies suggesting that testicular lesions <10 mm in maximum diameter are mostly benign . We also have found that orchidectomy has been overused and, in some cases, has even been unnecessary as a consequence of the combination of misleading tumour markers and equivocal radiology results.…”

Section: Discussionsupporting

confidence: 92%

“…Although, in other studies, the threshold used to distinguish malignant from benign lesions ranged from <2.5 to <1.5 cm , in our cohort all the lesions <5 mm in size (20%) showed benign histology and no malignant lesions have been found with this diameter size.…”

Section: Discussioncontrasting

confidence: 58%

“…The introduction of and improvements in ultrasonography have led to an increase in the detection of small testicular lesions. A summary of the results from studies reporting benign and malignant testicular lesions <10 mm in diameter is shown in Table .…”

Section: Discussionmentioning

confidence: 99%

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Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?

et al. 2017

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The majority of testicular lesions <10 mm, identified by radiology, were benign, although approxmiately one-third were malignant. In the present study, 100% of lesions <5 mm in diameter were benign. Tumour markers appear to be unhelpful in the distinction of these small tumours. We suggest that regular ultrasound surveillance be more widely used for testicular lesions of this size. Testicular tumours now have a very high cure rate and changes in size of lesions may be monitored prospectively with minimal risk of increased morbidity. Patients who undergo an orchidectomy for lesions <5 mm are 'victims of modern imaging technology'. If surgery is undertaken in lesions 5-10 mm, patients should be counselled that two-thirds of cases are benign.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 58%

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Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?

et al. 2017

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“…Ye et al (24) retrospectively reviewed the trend of TSS for pediatric testicular tumors in South China, and advocated the potential benefits of this procedure. Keske et al (25) showed a significant decrease in neighboring testis ITGCN but increase in multifocality, hence advised caution and safety rim of normal tissue within the resection margin. Bojanic et al (26) even made a big step forward by evaluating the feasibility of TSS in GCTs alone.…”

Section: Discussionmentioning

confidence: 99%

Radical and testis‑sparing surgery for primary testicular tumors: A single‑center experience

et al. 2018

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The aim of the present study was to assess the oncological and functional outcomes of testis-sparing surgery (TSS) for testicular tumors compared with radical orchiectomy (RO) in a single center. A retrospective comparative cohort study was conducted in Changzheng Hospital. Patients were identified using the hospital information system from January 1999 to December 2016, collecting all of the data regarding clinical, treatment and prognostic profiles. Patient follow-up was also executed to obtain information on patients' survival status, serum markers profiles, disease progression, androgen substitution requirement and paternity status. In total 158 patients were enrolled into the cohort study, including 23 TSS cases. The TSS procedure was primarily conducted in younger patients (average age, 31.9 vs. 47.7 years) or those with smaller tumors (average tumor diameter, 26.0 vs. 51.5 mm). The overall survival and recurrence free survival revealed no differences in the two groups, suggesting similar oncological outcomes. Kaplan-Maier analysis demonstrated a higher cumulative paternity rate in the TSS group than in RO group, indicating a possible advantage of preserving patients' fertility in TSS over RO. TSS with proper adjuvant therapies proved to be a promising alternative in the avoidance of emasculation, infertility, life-long androgen substitution and other psychosexual difficulties, as the oncological outcomes were not inferior to RO in the selected cases. However, further investigation is required in order to assess its oncological and functional values.

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“…In these cases, orchiectomy could be considered an overtreatment, assuming that the patient would become infertile after the procedure (6). Recent studies have shown that in these cases of small scrotal masses, testis-sparing surgery is a reliable and secure option, although some articles point out the concern of multifocal tumors; therefore, an excision contemplating a 1 cm safety rim of normal testicle tissue should be performed in addition to the tumoral mass, diminishing the risk of leaving malignant satellite lesions (7).…”

mentioning

confidence: 99%

Testicular Cancer—Surgical Treatment

2019

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Testicular Germ Cell Tumor (GCT) is the most common solid tumor in men between the ages of 20–44. Men diagnosed with GCT have excellent survival rates due to advances in the multimodal treatment paradigm of chemotherapy, radiation therapy, and surgery. When considering the adequate treatment, several variables should be investigated and known to select the proper procedure. Therefore, when considering Testicular Intra-Epithelial Neoplasia, organ-sparring treatment, such as radiotherapy or organ-sparring surgery should be considered, reaching a cure rate of 98%. However, when the case is of a seminoma or a non-seminoma, orchiectomy is usually the chosen procedure, reaching an oncological cure rate of 80–85%, when there is no metastasis. Retroperitoneal Lymph Node Dissection (RPLND) is generally considered as a treatment option for non-seminomas, when lymph nodes are compromised. There are three different RPLND techniques: open, laparoscopic, and robotic. The open approach is as effective as the other two in its oncological efficiency. Although, when considering both laparoscopic and robotic approach, hospital stays are significantly reduced, better cosmetic results, and less complications when compared to the open approach. Both laparoscopic and robotic approaches require extensive experience and have a steep learning curve, while also providing similar outcome, however, recent studies have been pointing out a slight increase of advantages on the robotic approach. Therefore, further studies are necessary to assert the robotic approach superiority. Also, it is noteworthy that new technologies are on the rise, improving the laparoscopic approach, requiring further studies after their uses are consolidated.

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Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study

Abstract: Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

Cited by 13 publications

References 13 publications

Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?

Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?

Radical and testis‑sparing surgery for primary testicular tumors: A single‑center experience

Testicular Cancer—Surgical Treatment

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