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

Abstract

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.

Outcomes of organ‐sparing surgery for adult testicular tumors: A systematic review of the literature

“…In fact, up to 21% of men are lost to follow‐up in these series. Thus patient selection and cautious, frequent follow‐up with integration of US is necessary until improved protocols are developed 54,55 . According to current guidelines, testis‐sparing surgery can be considered in patients with bilateral GCT or a solitary testis with a mass suspicious for GCT 53,56 .…”

4 mm’lik testis tümörüne ultrason eşliğinde işaretleme ile organ koruyucu cerrahi

“…Ek olarak bu çalışmada yakın gelecekte baba olmayı planlayan hastalar ve testis kaybı veya ömür boyu androjen takviyesi olasılığını kabul edemeyen hastalarda TKC 'nin düşünülmesi gerektiği önerilmiştir. [21] Bojanic ve ark. TKC'nin GHT'lerde uygulanabilirliğini değerlendirmişlerdir.…”

Additional Preoperative Parameters to Enable the Decision of Partial Orchiectomy in Small Testicular Masses

“…It is known that hypogonadism develop in 10-20% of patients after radical orchiectomy. For this reason, partial orchiectomy is a treatment strategy that has been tried to be popularized in order to protect fertility, reduce the need for lifelong androgen supplementation and psychosexual problems that may occur, especially in young patients without children (8). It was stated that sufficient Leydig cell reserves could be maintained to ensure testosterone production with partial orchiectomy (8).…”

“…For this reason, partial orchiectomy is a treatment strategy that has been tried to be popularized in order to protect fertility, reduce the need for lifelong androgen supplementation and psychosexual problems that may occur, especially in young patients without children (8). It was stated that sufficient Leydig cell reserves could be maintained to ensure testosterone production with partial orchiectomy (8). However, the main drawback in this practice is insufficient or incomplete resection of the tumor due to microinvasions that may be overlooked.…”

“…Benign pathology has been reported in 60-80% of small testicular masses with normal tumor markers, and current studies suggest that radical orchiectomy is an extreme treatment in these cases (4,6,7). As a result, we have seen recent studies advocating the applicability of partial orchiectomy in small, unilateral tumors (6,8).…”