Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Patient Eligibility
3.2. Surgical Technique
3.3. Complications
3.4. Oncological Outcomes
3.5. Functional Outcomes
3.6. Strengths and Limitations
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Testicular Cancer Statistics. Cancer Research UK. Available online: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/testicular-cancer (accessed on 2 May 2023).
- Smith, Z.L.; Werntz, R.P.; Eggener, S.E. Testicular Cancer. Med. Clin. N. Am. 2018, 102, 251–264. [Google Scholar] [CrossRef] [PubMed]
- Gurney, J.K.; Florio, A.A.; Znaor, A.; Ferlay, J.; Laversanne, M.; Sarfati, D.; Bray, F.; McGlynn, K.A. International Trends in the Incidence of Testicular Cancer: Lessons from 35 Years and 41 Countries. Eur. Urol. 2019, 76, 615–623. [Google Scholar] [CrossRef] [PubMed]
- Berney, D.M.; Cree, I.; Rao, V.; Moch, H.; Srigley, J.R.; Tsuzuki, T.; Amin, M.B.; Comperat, E.M.; Hartmann, A.; Menon, S.; et al. An introduction to the WHO 5th edition 2022 classification of testicular tumours. Histopathology 2022, 81, 459–466. [Google Scholar] [CrossRef]
- Moch, H.; Amin, M.B.; Berney, D.M.; Compérat, E.M.; Gill, A.J.; Hartmann, A.; Menon, S.; Raspollini, M.R.; Rubin, M.A.; Srigley, J.R.; et al. The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs—Part A: Renal, Penile, and Testicular Tumours. Eur. Urol. 2022, 82, 458–468. [Google Scholar] [CrossRef] [PubMed]
- Dotzauer, R.; Salamat, A.; Nabar, N.D.; Thomas, A.; Böhm, K.; Brandt, M.P.; Mager, R.; Borgmann, H.; Kurosch, M.; Hoefner, T.; et al. The timing of initial imaging in testicular cancer: Impact on radiological findings and clinical decision making. Minerva Urol. Nephrol. 2022, 74, 72–76. [Google Scholar] [CrossRef]
- Nord, C.; Bjøro, T.; Ellingsen, D.; Mykletun, A.; Dahl, O.; Klepp, O.; Bremnes, R.M.; Wist, E.; Fosså, S.D. Gonadal Hormones in Long-Term Survivors 10 Years after Treatment for Unilateral Testicular Cancer. Eur. Urol. 2003, 44, 322–328. [Google Scholar] [CrossRef]
- Petersen, P.M.; Skakkebæk, N.E.; Vistisen, K.; Rørth, M.; Giwercman, A. Semen Quality and Reproductive Hormones before Orchiectomy in Men with Testicular Cancer. J. Clin. Oncol. Off J. Am. Soc. Clin. Oncol. 1999, 17, 941–947. [Google Scholar] [CrossRef]
- Ory, J.; Blankstein, U.; Gonzalez, D.C.; Sathe, A.A.; White, J.T.; 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. [Google Scholar] [CrossRef]
- Ramos, S.A.; Pinheiro, A.M.; Barcelos, A.P.; Cardoso, A.P.; Varregoso, J. Satisfaction with testicular prosthesis: A Portuguese questionnaire-based study in testicular cancer survivors. Rev. Int. Androl. 2022, 20, 110–115. [Google Scholar] [CrossRef]
- Grogg, J.B.; Dursun, Z.H.; Beyer, J.; Eberli, D.; Poyet, C.; Hermanns, T.; Fankhauser, C.D. 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. [Google Scholar] [CrossRef]
- La Rocca, R.; Capece, M.; Spirito, L.; Cumberbatch, M.K.; Creta, M.; Altieri, V.; Franco, G.; Albisinni, S.; Mirone, V.; Esperto, F.; et al. Testis-sparing surgery for testicular masses: Current perspectives. Minerva Urol. Nefrol. Ital. J. Urol. Nephrol. 2019, 71, 359–364. [Google Scholar] [CrossRef] [PubMed]
- Leonhartsberger, N.; Pichler, R.; Stoehr, B.; Horninger, W.; Steiner, H. Organ-sparing surgery is the treatment of choice in benign testicular tumors. World J. Urol. 2014, 32, 1087–1091. [Google Scholar] [CrossRef] [PubMed]
- Borghesi, M.; Brunocilla, E.; Schiavina, R.; Gentile, G.; Dababneh, H.; Della Mora, L.; del Prete, C.; Franceschelli, A.; Colombo, F.; Martorana, G. Role of testis sparing surgery in the conservative management of small testicular masses: Oncological and functional perspectives. Actas Urol. Esp. 2014, 39, 57–62. [Google Scholar] [CrossRef] [PubMed]
- EAU Guidelines on Testicular Cancer-Introduction-Uroweb. Uroweb-European Association of Urology. Available online: https://uroweb.org/guidelines/testicular-cancer (accessed on 4 June 2023).
- Patel, H.D.; Gupta, M.; Cheaib, J.G.; Sharma, R.; Zhang, A.; Bass, E.B.; Pierorazio, P.M. Testis-sparing surgery and scrotal violation for testicular masses suspicious for malignancy: A systematic review and meta-analysis. Urol. Oncol. Semin. Orig. Investig. 2020, 38, 344–353. [Google Scholar] [CrossRef] [PubMed]
- Heidenreich, A.; Albers, P.; Krege, S. Management of bilateral testicular germ cell tumors--experience of the German Testicular Cancer Study Group (GTCSG). Eur. Urol. Suppl. 2006, 5, 97. [Google Scholar] [CrossRef]
- Heidenreich, A.; Engelmann, U.H.; Vietsch, H.V.; Derschum, W. Organ preserving surgery in testicular epidermoid cysts. J. Urol. 1995, 153, 1147–1150. [Google Scholar] [CrossRef]
- Giannarini, G.; Mogorovich, A.; Bardelli, I.; Manassero, F.; Selli, C. Testis-sparing surgery for benign and malignant tumors: A critical analysis of the literature. Indian J. Urol. 2008, 24, 467–474. [Google Scholar] [CrossRef]
- Paffenholz, P.; Held, L.; Loosen, S.H.; Pfister, D.; Heidenreich, A. Testis Sparing Surgery for Benign Testicular Masses: Diagnostics and Therapeutic Approaches. J. Urol. 2018, 200, 353–360. [Google Scholar] [CrossRef]
- Sheynkin, Y.R.; Sukkarieh, T.; Lipke, M.; Cohen, H.L.; Schulsinger, D.A. Management of nonpalpable testicular tumors. Urology 2004, 63, 1163–1167. [Google Scholar] [CrossRef]
- Rolle, L.; Tamagnone, A.; Destefanis, P.; Bosio, A.; Timpano, M.; Fiori, C.; Ceruti, C.; Burlo, P.; Fauciglietti, P.; Fontana, D. Microsurgical “testis-sparing” surgery for nonpalpable hypoechoic testicular lesions. Urology 2006, 68, 381–385. [Google Scholar] [CrossRef]
- Brunocilla, E.; Gentile, G.; Schiavina, R.; Borghesi, M.; Franceschelli, A.; Pultrone, C.V.; Chessa, F.; Romagnoli, D.; Ghanem, S.M.; Gacci, M.; et al. Testis-sparing surgery for the conservative management of small testicular masses: An update. Anticancer. Res. 2013, 33, 5205–5210. [Google Scholar] [PubMed]
- Shilo, Y.; Zisman, A.; Raz, O.; Lang, E.; Strauss, S.; Sandbank, J.; Segal, M.; Siegel, Y.I.; Leibovici, D. Testicular sparing surgery for small masses. Urol. Oncol. Semin. Orig. Investig. 2012, 30, 188–191. [Google Scholar] [CrossRef] [PubMed]
- De Stefani, S.; Isgrò, G.; Varca, V.; Pecchi, A.; Bianchi, G.; Carmignani, G.; Derchi, L.E.; Micali, S.; Maccio, L.; Simonato, A. Microsurgical Testis-sparing Surgery in Small Testicular Masses: Seven Years Retrospective Management and Results. Urology 2012, 79, 858–862. [Google Scholar] [CrossRef] [PubMed]
- Giannarini, G.; Dieckmann, K.-P.; Albers, P.; Heidenreich, A.; Pizzocaro, G. Organ-Sparing Surgery for Adult Testicular Tumours: A Systematic Review of the Literature. Eur. Urol. 2010, 57, 780–790. [Google Scholar] [CrossRef] [PubMed]
- Staudacher, N.; Tulchiner, G.; Bates, K.; Ladurner, M.; Kafka, M.; Aigner, F.; Pichler, R.; Horninger, W. Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm? J. Clin. Med. 2020, 9, 2911. [Google Scholar] [CrossRef] [PubMed]
- Heidenreich, A.; Seelemeyer, F.; Altay, B.; Laguna, M.P. Testis-sparing Surgery in Adult Patients with Germ Cell Tumors: Systematic Search of the Literature and Focused Review. Eur. Urol. Focus 2023, 9, 244–247. [Google Scholar] [CrossRef]
- Muñoz, M.I.R.; Cerezo, V.N.; Reyes, M.D.; Sánchez, A.V.; González-Peramato, P.; Pereira, P.L.; Urrutia, M.J.M. Testicular tumours in children: Indications for testis-sparing surgery. An. Pediatría 2018, 88, 253–258. [Google Scholar] [CrossRef]
- Woo, L.L.; Ross, J.H. The role of testis-sparing surgery in children and adolescents with testicular tumors. Urol. Oncol. Semin. Orig. Investig. 2016, 34, 76–83. [Google Scholar] [CrossRef]
- Valla, J.S.; the Group D’Etude en Urologie Pédiatrique. Testis-sparing surgery for benign testicular tumors in children. J. Urol. 2001, 165 Pt 2, 2280–2283. [Google Scholar] [CrossRef]
- Jungwirth, A.; Giwercman, A.; Tournaye, H.; Diemer, T.; Kopa, Z.; Dohle, G.; Krausz, C.; EAU Working Group on Male Infertility. European Association of Urology Guidelines on Male Infertility: The 2012 Update. Eur. Urol. 2012, 62, 324–332. [Google Scholar] [CrossRef]
- Stephenson, A.; Eggener, S.E.; Bass, E.B.; Chelnick, D.M.; Daneshmand, S.; Feldman, D.; Gilligan, T.; Karam, J.A.; Leibovich, B.; Liauw, S.L.; et al. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J. Urol. 2019, 202, 272–281. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Stoll, S.; Goldfinger, M.; Rothberg, R.; Buckspan, M.; Fernandes, B.; Bain, J. Incidental detection of impalpable testicular neoplasm by sonography. Am. J. Roentgenol. 1986, 146, 349–350. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hopps, C.V.; Goldstein, M. Ultrasound Guided Needle Localization and Microsurgical Exploration for Incidental Nonpalpable Testicular Tumors. J. Urol. 2002, 168, 1084–1087. [Google Scholar] [CrossRef] [PubMed]
- Zuniga, A.; Lawrentschuk, N.; Jewett, M.A.S. Organ-sparing approaches for testicular masses. Nat. Rev. Urol. 2010, 7, 454–464. [Google Scholar] [CrossRef] [PubMed]
- Whitehurst, L.; Chetwood, A. Organ Sparing Surgery in Testicular Cancer. In Urologic Cancers; Barber, N., Ali, A., Eds.; Exon Publications: Brisbane, Australia, 2022. Available online: http://www.ncbi.nlm.nih.gov/books/NBK585984/ (accessed on 21 May 2023).
- Hallak, J.; Cocuzza, M.; Sarkis, A.S.; Athayde, K.S.; Cerri, G.G.; Srougi, M. Organ-Sparing Microsurgical Resection of Incidental Testicular Tumors Plus Microdissection for Sperm Extraction and Cryopreservation in Azoospermic Patients: Surgical Aspects and Technical Refinements. Urology 2009, 73, 887–891. [Google Scholar] [CrossRef]
- Favilla, V.; Cannarella, R.; Tumminaro, A.; DI Mauro, D.; Condorelli, R.A.; LA Vignera, S.; Ficarra, V.; Cimino, S.; Calogero, A.E. Oncological and functional outcomes of testis sparing surgery in small testicular mass: A systematic review. Minerva Urol. Nephrol. 2021, 73, 431–441. [Google Scholar] [CrossRef]
- Simultaneous Bilateral Tumors with Unorthodox Management|CiNii Research. Available online: https://cir.nii.ac.jp/crid/1570854174607762048 (accessed on 21 May 2023).
- Heidenreich, A.; Weißbach, L.; Höltl, W.; Albers, P.; Kliesch, S.; Köhrmann, K.U.; Klaus, P.; Dieckmann For The German Testicular Cancer Study Group. Organ sparing surgery for malignant germ cell tumor of the testis. J. Urol. 2001, 166, 2161–2165. [Google Scholar] [CrossRef]
- Bojanic, N.; Bumbasirevic, U.; Vukovic, I.; Bojanic, G.; Milojevic, B.; Nale, D.; Durutovic, O.; Djordjevic, D.; Nikic, P.; Vuksanovic, A.; et al. Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: A single institution experience. J. Surg. Oncol. 2015, 111, 226–230. [Google Scholar] [CrossRef]
- Steiner, H.; Höltl, L.; Maneschg, C.; Berger, A.P.; Rogatsch, H.; Bartsch, G.; Hobisch, A. Frozen section analysis-guided organ-sparing approach in testicular tumors: Technique, feasibility, and long-term results. Urology 2003, 62, 508–513. [Google Scholar] [CrossRef]
- von der Maase, H.; Rorth, M.; Walbom-Jorgensen, S.; Sorensen, B.L.; Christophersen, I.S.; Hald, T.; Jacobsen, G.K.; Berthelsen, J.G.; Skakkebaek, N.E. Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: Study of 27 cases in 500 patients. BMJ 1986, 293, 1398–1401. [Google Scholar] [CrossRef] [Green Version]
- Dieckmann, K.-P.; Tribius, S.; Angerer, M.; Salzbrunn, A.; von Kopylow, K.; Mollenhauer, M.; Wülfing, C. Testicular germ cell tumour arising 15 years after radiotherapy with 18 Gy for germ cell neoplasia in situ. Strahlenther. Und Onkol. 2023, 199, 322–326. [Google Scholar] [CrossRef] [PubMed]
- Avuzzi, B.; Tittarelli, A.; Andreani, S.; Chiorda, B.N.; Seregni, E.; Villa, S.; Tana, S.; Valdagni, R.; Salvioni, R.; Biasoni, D.; et al. Radiotherapy after testis-sparing surgery for seminoma in monorchid patients: Safety and efficacy. Tumori J. 2022, 108, 165–171. [Google Scholar] [CrossRef] [PubMed]
- Paffenholz, P.; Pfister, D.; Heidenreich, A. Testis-preserving strategies in testicular germ cell tumors and germ cell neoplasia in situ. Transl. Androl. Urol. 2020, 9 (Suppl. 1), S24–S30. [Google Scholar] [CrossRef] [PubMed]
- Miao, X.; Li, Y.; Zhou, T.; Lv, M. Testis-sparing surgery in children with testicular tumors: A systematic review and meta-analysis. Asian J. Surg. 2021, 44, 1503–1509. [Google Scholar] [CrossRef]
- Parekh, N.V.; Lundy, S.D.; Vij, S.C. Fertility considerations in men with testicular cancer. Transl. Androl. Urol. 2020, 9 (Suppl. 1), S14–S23. [Google Scholar] [CrossRef]
- Lee, S.H.; Shin, C.H. Reduced male fertility in childhood cancer survivors. Ann. Pediatr. Endocrinol. Metab. 2013, 18, 168–172. [Google Scholar] [CrossRef] [Green Version]
- Ku, J.Y.; Park, N.C.; Jeon, T.G.; Park, H.J. Semen Analysis in Cancer Patients Referred for Sperm Cryopreservation before Chemotherapy over a 15-Year Period in Korea. World J. Men’s Heal. 2015, 33, 8–13. [Google Scholar] [CrossRef] [Green Version]
- Pozza, C.; Pofi, R.; Tenuta, M.; Tarsitano, M.G.; Sbardella, E.; Fattorini, G.; Cantisani, V.; Lenzi, A.; Isidori, A.M.; Gianfrilli, D.; et al. Clinical presentation, management and follow-up of 83 patients with Leydig cell tumors of the testis: A prospective case-cohort study. Hum. Reprod. 2019, 34, 1389–1403. [Google Scholar] [CrossRef] [Green Version]
Patient Factors | Tumor Factors |
---|---|
Normal Levels of Testosterone and Luteinizing Hormone Pre-Surgery | Tumor Size < 50% of the Testis/<2 cm |
Solitary Testes | Bilateral Synchronous or Metachronous Tumors |
Indeterminate Findings on Ultrasound | |
Negative Tumor Markers | |
No Invasion of the Rete Testis |
Author and Year | Number of Studies Included | Number of Patients | Median Follow-Up | Oncological Outcomes | Conclusions |
---|---|---|---|---|---|
Ory et al., 2021 [9] | 32 | N/A | 57.8 months | N/A (No Meta-Analysis Conducted) | TSS is a safe and efficacious technique with regard to oncological control based on retrospective, non-controlled studies. TSS avoids unnecessary removal of benign testicular tissue and should be given serious consideration in cases of nonpalpable, small tumors under 2 cm. |
Favilla et al., 2021 [39] | 26 | 603 | Not Specified | Local recurrence of 3.48%. Overall recurrence: 0% to 26.9% for malignancy and from 0% to 0.1% for benign lesions. | TSS was shown to be safe and practicable if used according to the specific guidelines. Urologists can consider TSS as an important means against testicular tumors in selected and well-informed patients. |
Miao et al., 2021 [48] | 9 | 320. Only Children. | Not Specified | Local recurrence 5.8% (benign rate was 70.9%) | Most of the testicular tumors in children were benign, and the most common histologic subtype was teratoma. TSS should be provided to children with benign lesions. Very low rates of tumor recurrence were observed in children with testicular tumors. |
Grogg et al., 2022 [11] | 32 | 285 | 38 months | Local recurrence: 13% (median 12 months), 97% disease-free after treatment for recurrence. 2% distant recurrence (median 19 months). Disease-free post-systemic treatment during a median follow-up of 52 months. | 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. Radical orchiectomy remains the standard of care, but future studies may support the use of TSS in selected men. |
Heidenreich et al., 2023 [28] | 8 | 252 | Not Specified | Local recurrence 4–6% to 15.9%. 2–4% Distant recurrence. Cancer-specific survival close to 100%. | Oncological outcomes are excellent, with no local relapses if patients undergo adjuvant radiation therapy. The local recurrence rate might increase to 4–6% if adjuvant radiation is omitted. |
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García Rojo, E.; Giannarini, G.; García Gómez, B.; Feltes Ochoa, J.A.; Guerrero Ramos, F.; Alonso Isa, M.; Brime Menendez, R.; Saenz Calzada, D.M.; Justo Quintas, J.; Fraile, A.; et al. Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective. Medicina 2023, 59, 1249. https://doi.org/10.3390/medicina59071249
García Rojo E, Giannarini G, García Gómez B, Feltes Ochoa JA, Guerrero Ramos F, Alonso Isa M, Brime Menendez R, Saenz Calzada DM, Justo Quintas J, Fraile A, et al. Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective. Medicina. 2023; 59(7):1249. https://doi.org/10.3390/medicina59071249
Chicago/Turabian StyleGarcía Rojo, Esther, Gianluca Giannarini, Borja García Gómez, Javier Amalio Feltes Ochoa, Félix Guerrero Ramos, Manuel Alonso Isa, Ricardo Brime Menendez, David Manuel Saenz Calzada, Juan Justo Quintas, Agustín Fraile, and et al. 2023. "Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective" Medicina 59, no. 7: 1249. https://doi.org/10.3390/medicina59071249