To demonstrate safety and efficacy of testis sparing surgery (TSS) in two specific circumstances: small, non-palpable masses suspected to be benign and masses suspicious for germ cell tumor (GCT) in a solitary or functionally solitary testicle or bilateral disease.
Our IRB-approved testicular cancer registry was reviewed for men who underwent inguinal exploration with intent for TSS (2013-2020). The attempted TSS and completed TSS groups were evaluated for differences using Student's t-test for normally-distributed variables, chi-squared and Fisher's exact tests for proportions, and Wilcoxon rank-sum test for non-parametric variables.
TSS was attempted in 28 patients and completed in 14. TSS was completed only if intraoperative frozen section demonstrated benign disease, except for one patient with stage I seminoma and solitary testicle. Sensitivity and specificity of frozen section analysis was 100% and 93%, respectively. There were no significant differences in demographics between attempted vs. completed TSS cohorts. Median tumor size was significantly smaller in the completed TSS cohort (1.0 cm vs 1.7 cm, p=0.03). In patients with unilateral masses without history of testis cancer, the testis was successfully spared in 9/22 (41%) cases. In patients with bilateral disease or germ cell tumor in solitary testis, the testis was spared in 5/6 (83%) cases. At a median follow up of 12.2 months, all patients were alive, and 27/28 (96%) had no evidence of disease.
TSS is safe and effective for small, benign masses and in the setting of bilateral disease or tumors in a solitary testis.
Urology. 2020 Oct 30 [Epub ahead of print]
Jillian Egan, Joseph G Cheaib, Michael J Biles, Mitchell M Huang, Meredith Metcalf, Andres Matoso, Phillip Pierorazio
Department of Urology, MedStar Georgetown University Hospital, Washington DC, USA., Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore MD, USA., Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore MD, USA; Department of Pathology, Johns Hopkins University, Baltimore, MD, USA., Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore MD, USA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33137349