Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: A single institution experience

Abstract

TSS is acceptable from an oncological point of view, and it enables continuation of a patient's life without lifelong hormonal substitution. Additionally, local irradiation therapy could be delayed in patients with TIN who wish to father children, but with high local recurrence rate.

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

“…This was shown in an analysis by Giannarini et al [10] reviewing the literature on testis-sparing procedures, which showed that 74.8% of resected tumors were of benign histology and would have been overtreated with radical orchiectomy. In the case of a germ cell tumor pathology, there is a high incidence of GCNIS (13.3-90.9%) [4,9,11,12,13]. GCNIS is associated with a significant risk of local recurrence.…”

“…GCNIS is associated with a significant risk of local recurrence. Bojanovic et al [11] analyzed their collective with regard to local recurrence due to the presence of GCNIS. In patients without GCNIS, 10-year recurrence-free survival was 82%.…”

“…Lawrentschuk et al [9 ]describes 2 local recurrences in 17 patients with a malignant pathology and only 1 retroperitoneal metastatic progression. Bojanovic et al [14] showed local recurrence in 10% (n = 1) of their cohort, whereas in a former analysis there was a significantly higher rate of 7 local recurrences and 1 systemic progression among 24 patients [11]. …”

The role of testis-sparing surgery in children and adolescents with testicular tumors

“…Testosterone levels remained normal in all patients, though 2 became azoospermic after surgery. Paternity was achieved in 4 cases, 2 of which by spontaneous conception and 2 by assisted reproductive techniques [40]. The theoretical functional advantages of TSS must be tempered by the observation that postsurgical gonadal function in these patients may be inherently abnormal, related to preexisting germ cell dysfunction associated with testis cancer or represent damage secondary to ischemia from cord clamping, the creation of antisperm antibodies, and the effects of adjuvant radiation.…”

Intratubular Germ Cell Neoplasia of the Testis, Bilateral Testicular Cancer, and Aberrant Histologies

“…54 It is typically indicated for organ confined tumors less than 3 cm in clinical diameter with use of biopsies of the tumor bed to rule out adjacent ITGCN and assess margin status. 55 Adjuvant XRT can also reduce local recurrence rates, although this can affect long-term fertility.…”