Testis-Sparing Surgery in Patients with Germ Cell Cancer: Indications and Clinical Outcome

Pfister, D.; Paffenholz, Pia; Haidl, Friederike

doi:10.1159/000489346

Cited by 8 publications

(3 citation statements)

References 15 publications

(23 reference statements)

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Objective To perform a systematic review on the effects of testicular sparing surgery (TSS) on the oncological, functional, and hormonal outcomes of adults with testicular tumors. Methods A literature search was performed after PROSPERO registration (CRD42020200842) and reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methods. We conducted a systematic search of Medline (Ovid), Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and the WHO/ICTRP from inception to November 20, 2020. Manuscripts and published abstracts were included if they involved testis‐sparing surgery (TSS) and contained data on any outcomes related to fertility, hormonal parameters, or oncological control, or if they evaluated surgical technique. Results Our initial search yielded 3,370 manuscripts, with 269 of these screened for full‐text eligibility. After our exclusion criteria were applied, 32 studies were included in the final analysis. Oncological outcomes were obtained from 12 studies (average follow‐up 57.8 months), functional data from 26 studies (average follow‐up 49.6 months), fertility information from 10 studies (average follow‐up 55.8 months), and data on nonpalpable tumors from 11 studies (average follow‐up 32.1 months). Oncological control appears to be excellent in studies that reported these outcomes. Presence of germ cell neoplasia in situ was controlled with adjuvant radiation in nearly all cases. Functional outcomes are also promising, as development of primary and compensated hypogonadism was rare. Semen parameters are poor preoperatively among men with benign and malignant testis tumors, with occasional decline after TSS. Frozen section analysis at the time of surgery appears to be very reliable, and the majority of nonpalpable tumors appear to be benign. Conclusions TSS is a safe and efficacious technique with regards to oncological control and postoperative hormonal function based on retrospective, noncontrolled studies. TSS avoids unnecessary removal of benign testicular tissue, and should be given serious consideration in cases of nonpalpable, small tumors under 2 cm. In cases of malignancy, TSS can safely avoid anorchia in men with bilateral tumors and in men with solitary testicles. The use of the operating microscope, while theoretically promising, does not necessarily lead to better outcomes, however data are limited.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…The increased detection rates of small, impalpable, benign testicular masses as a result of advanced imaging techniques has raised an important question in modern urological practice regarding the optimum management of such lesions. To date there is no definitive approach and the EAU recommendations above affirm the role of operative intervention in the form of partial orchidectomy in such patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Brown

Tsampoukas

Popov³

et al. 2021

Arab Journal of Urology

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Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of ≤5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low.

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“…In the first article of the present Focus, Pfister et al [5] highlight the issue of testis-sparing surgery in men with synchronous or metachronous TGCT which is the treatment of choice according to the current guidelines. This article also deals with the optimal approach for patients with testicular tumors of uncertain dignity, e.g.…”

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confidence: 99%

Interdisciplinary Management of Testicular Germ Cell Tumors - More Needed than Ever!

Heidenreich

2018

Oncol Res Treat

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Testis-Sparing Surgery in Patients with Germ Cell Cancer: Indications and Clinical Outcome

Cited by 8 publications

References 15 publications

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

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

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Interdisciplinary Management of Testicular Germ Cell Tumors - More Needed than Ever!

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