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Keske M, Canda AE, Karadag MA, Çiftçi H, Erturhan S, Kactan C, Soytas M, Özkaya F, Ozbey I, Ordek E, Atmaca AF, Yildirim A, Sahin S, Colakoglu Y, Boylu U, Erol B, Caskurlu T, Kiremit MC, Cakici OU, Sonmez G, Kılıçarslan H, Akbulut Z, Kaygısız O, Bedir S, Vuruskan H, Bozkurt YE, Aydin HR, Oguz U, Basok EK, Gumus BH, Tuncel A, Aslan Y, Hamidi N, Müslümanoğlu AY, Dinçer M, Balbay D, Albayrak S, Laguna MP. A Retrospective Analysis of 83 Patients with Testicular Mass Who Underwent Testis-Sparing Surgery: The Eurasian Uro-oncology Association Multicenter Study. Urol Int 2023; 107:857-865. [PMID: 37591208 DOI: 10.1159/000531645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/06/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Herein, we analyzed the histopathological, oncological and functional outcomes of testis-sparing surgery (TSS) in patients with distinct risk for testicular cancer. METHODS This is a multicenter retrospective study on consecutive patients who underwent TSS. Patients were categorized in high- or low-risk testicular germ cell tumor (TGCT) according to the presence/absence of features compatible with testicular dysgenesis syndrome. Histology was categorized per size and risk groups. RESULTS TSS was performed in 83 patients (86 tumors) of them, 27 in the high-risk group. Fifty-nine patients had a non-tumoral contralateral testis present. Sixty masses and 26 masses were benign and TGCTs, respectively. No statistical differences were observed in mean age (30.9 ± 10.32 years), pathological tumor size (14.67 ± 6.7 mm) between risk groups or between benign and malignant tumors (p = 0.608). When categorized per risk groups, 22 (73.3%) and 4 (7.1%) of the TSS specimens were malignant in the high- and low-risk patient groups, respectively. Univariate analysis showed that the only independent variable significantly related to malignant outcome was previous history of TGCT. During a mean follow-up of 25.5 ± 22.7 months, no patient developed systemic disease. Local recurrence was detected in 5 patients and received radical orchiectomy. Postoperative testosterone levels remained normal in 88% of those patients with normal preoperative level. No erectile dysfunction was reported in patients with benign lesions. CONCLUSION TSS is a safe and feasible approach with adequate cancer control, and preservation of sexual function is possible in 2/3 of patients harboring malignancy. Incidence of TGCT varies extremely between patients at high and low risk for TGCT requiring a careful consideration and counseling.
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Affiliation(s)
- Murat Keske
- University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | | | - Mert Ali Karadag
- University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | - Halil Çiftçi
- Department of Urology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Sakip Erturhan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cagri Kactan
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Fatih Özkaya
- Department of Urology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Isa Ozbey
- Department of Urology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Eser Ordek
- Department of Urology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Memorial Ankara Hospital, Ankara, Turkey
| | - Asif Yildirim
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences Affiliated with Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Colakoglu
- Department of Urology, University of Health Sciences Affiliated with Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ugur Boylu
- Department of Urology, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Erol
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Turhan Caskurlu
- Department of Urology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Ozer Ural Cakici
- Department of Urology, Medical Park Ankara Hospital, Ankara, Turkey
| | - Gokhan Sonmez
- Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Kılıçarslan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Ziya Akbulut
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Onur Kaygısız
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Selahattin Bedir
- Department of Urology, University of Health Sciences Affiliated with Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hakan Vuruskan
- Department of Urology, Uludag University, School of Medicine, Bursa, Turkey
| | - Yunus Erol Bozkurt
- Department of Urology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Hasan Riza Aydin
- Department of Urology, University of Health Sciences Affiliated with Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ural Oguz
- Department of Urology, Giresun University, School of Medicine, Giresun, Turkey
| | - Erem Kaan Basok
- Department of Urology, Medical Park Izmir Hospital, Izmir, Turkey
| | - Bilal Habes Gumus
- Department of Urology, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey
| | | | - Murat Dinçer
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Derya Balbay
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Selami Albayrak
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Maria Pilar Laguna
- Department of Urology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Grogg JB, Dursun ZH, Beyer J, Eberli D, Poyet C, Hermanns T, Fankhauser CD. Oncological and functional outcomes after testis-sparing surgery in patients with germ cell tumors: a systematic review of 285 cases. World J Urol 2022; 40:2293-2303. [PMID: 35821265 PMCID: PMC9427883 DOI: 10.1007/s00345-022-04048-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In several urogenital cancers, organ-preserving surgery represents the preferred treatment approach, but in patients with testicular germ cell tumors (tGCTs), radical orchiectomy represents the standard of care. This study aimed to summarize published case series assessing oncological and functional outcomes after testis-sparing surgery (TSS) in patients with tGCTs. MATERIALS AND METHODS A systematic literature review and individual patient data meta-analysis were conducted of published cases with tGCT treated with TSS. RESULTS Of 2,333 reports, we included 32 reports providing data on 285 patients, including 306 testicles treated with TSS. Adjacent germ cell neoplasia in situ (GCNIS) was described in 43%. Hypogonadism and infertility after TSS were diagnosed in 27% and 18%. In patients undergoing adjuvant testicular radiotherapy, hypogonadism was diagnosed in 40%. Patients treated with adjuvant testicular radiotherapy after TSS exhibited a significantly lower incidence of local recurrence (2% vs. 50%, p < 0.001). Distant metastases after TSS were observed in 2%. CONCLUSION The current data questions the benefits of TSS in tGCT patients. If at all, TSS should only be offered to well-informed patients with a singular testicle, excellent compliance, a singular tumor less than 2 cm located at the lower pole of the testicle, and normal preoperative endocrine function. Unless patients plan to father a child within a short time frame, adjuvant testicular radiotherapy should be recommended after TSS. Radical orchiectomy remains the standard of care, but future studies may support the use of TSS in selected men.
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Affiliation(s)
| | | | - Joerg Beyer
- Department of Oncology, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Daniel Eberli
- Department of Urology, University of Zurich, Zurich, Switzerland
| | - Cedric Poyet
- Department of Urology, University of Zurich, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University of Zurich, Zurich, Switzerland
| | - Christian Daniel Fankhauser
- Department of Urology, University of Zurich, Zurich, Switzerland.
- Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
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Ory J, Blankstein U, Gonzalez DC, Sathe AA, White JT, Delgado C, Reynolds J, Jarvi K, Ramasamy R. Outcomes of organ-sparing surgery for adult testicular tumors: A systematic review of the literature. BJUI COMPASS 2021; 2:306-321. [PMID: 34568872 PMCID: PMC8462801 DOI: 10.1002/bco2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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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Affiliation(s)
- Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Udi Blankstein
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Daniel C Gonzalez
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aditya A Sathe
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua T White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Carlos Delgado
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Mexico
| | - John Reynolds
- Department of Health Informatics, Miller School of Medicine, University of Miami, Calder Memorial Library, Miami, FL, USA
| | - Keith Jarvi
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Pierconti F, Martini M, Grande G, Larocca LM, Sacco E, Pugliese D, Gulino G, Bassi PF, Milardi D, Pontecorvi A. Germ Cell Neoplasia in situ (GCNIS) in Testis-Sparing Surgery (TSS) for Small Testicular Masses (STMs). Front Endocrinol (Lausanne) 2019; 10:512. [PMID: 31440206 PMCID: PMC6692875 DOI: 10.3389/fendo.2019.00512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/12/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose: The testis-sparing surgery (TSS) is surgical technique accepted for small testicular masses (STMs). Frozen section examination (FSE) is an essential assessment at the time of TSS. The aim of this study is to measure the maximum distance of the foci of ITGCN from STMs. Methods: In our hospital between June 2010 and October 2017 a total of 68 patients with STM underwent a TSS. All the testis specimens were totally embedded and processed via the whole-mount method and a diagnosis of germ cell tumor with GCNIS were made. The distance between STMs and GCNIS were calculated by two pathologists directly on the slides considering for the third dimension the number of the paraffin blocks in which the foci of GCNIS were found. Results: The STMs were classic seminoma in 62 out 68 cases, embryonal carcinoma in 4 cases, while in 2 case a diagnose of mixed germ cell tumor were made. The size of the STMs was between 0.5 and 2 cm and the foci of GCNIS were observed in seminiferous tubules very closed to SMTs or as skip lesions in the surrounding testicular parenchyma, dispersed in normal testis. In 48 out of 68 cases (70.5%) foci of GCNIS were at the distance from SMTS of 1.5 cm or below and in 60 out of 68 cases (88%) at the distance of 2 cm or below The distance of GCNIS from the STMs was not related to the histological subtype of the germ cell tumor, while there is a linear correlation between size of the STMs and the distance of foci of GCNIS (p = 0.0105; r = 0.9167). Conclusion: Our data showed that foci of ITGCN were not observed beyond 2.5 cm from the STM. In particular we demonstrated that exist a linear correlation between size of STMs and distance of the foci of GCNIS from STMs (p = 0.0105; r = 0.9167). In conclusion mapping the tissue around the tumor not randomly but in targeted areas could reduce the false negative biopsies of the testis with GCNIS, increasing the radicality of the TSS procedure.
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Affiliation(s)
- Francesco Pierconti
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Francesco Pierconti
| | - Maurizio Martini
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Grande
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi M. Larocca
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pugliese
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Gulino
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pier F. Bassi
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Milardi
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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