Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective

Abstract

Background and Objectives: We aimed to evaluate the oncological and functional outcomes of organ-sparing surgery for testicular germ cell tumors, a procedure that seeks to strike a balance between effective cancer control and organ preservation, in the treatment of testicular tumors. We aimed to discuss the surgical technique and complications, and determine the appropriate candidate selection for this approach. Material and Methods: A comprehensive literature search was conducted to identify relevant studies on organ-sparing surgery for testicular tumors. Various databases, including PubMed, Embase, and Cochrane Library, were used. Studies reporting on surgical techniques, complications, and oncologic and functional outcomes were included for analysis. Results: Current evidence suggests that organ-sparing surgery for testicular germ cell tumors can be considered a safe and efficacious alternative to radical orchiectomy. The procedure is associated with adequate oncological control, as indicated by low recurrence rates and low complication rates. Endocrine testicular function can be preserved in around 80–90% of patients and paternity can be achieved in approximately half of the patients. Candidate selection for this surgery is typically based on the following criteria: pre-surgery normal levels of testosterone and luteinizing hormone, synchronous or metachronous bilateral tumors, tumor in a solitary testis, and tumor size less than 50% of the testis. Conclusions: Organ-sparing surgery for testicular germ cell tumors offers a promising approach that balances oncological control and preservation of testicular function. Further research, including large-scale prospective studies and long-term follow-ups, is warranted to validate the effectiveness and durability of organ-sparing surgery and to identify optimal patient selection criteria.

Myoid gonadal stromal tumor of the testis—the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature

“…(no.) Age (years) Tumor size (mm) Side l/r Treatment Outcome Evans 1977 [ 11 ] 4 35 L ox 3 m NED Greco 1984 [ 13 ] 24 20 NA ox 12 m NED 48 35 NA ox 32 m NED Miettinen 1986 [ 15 ] 52 37 NA ox 3 m NED Allen 1990 [ 16 ] 34 NA NA ox 36 m NED Weidner 1991 [ 12 ] 46 25 R ox 12 m NED Nistal 1996 [ 17 ] 16 13 L ox NA Renshaw 1997 …”

“…Based on the finding of a well-vascularized intratesticular mass upon ultrasonography, a testicular tumor was suspected. Accordingly, inguinal surgical exposure was performed with cord clamping and frozen-section-guided testis sparing excision (TSS) of the mass along with two marginal testicular biopsies, as recently advocated in a major review article [ 12 ].

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Testicular Cancer Treatments and Sexuality: A Narrative Review

“…Patients suspected of having TC should undergo an orchiectomy with inguinal access to remove the testicle that contains the tumor and the spermatic cord at the level of the inguinal ring [31]. Alternatively, if the testicle can be spared, surgeons usually prefer to perform a testis-sparing surgery [32].…”