Outcomes of organ‐sparing surgery for adult testicular tumors: A systematic review of the literature

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.

Discriminating malignant from benign testicular masses using machine-learning based radiomics signature of appearance diffusion coefficient maps: Comparing with conventional mean and minimum ADC values

“…In addition, concerns regarding FSA complications, including local recurrence and metastasis of malignancy, also exist [25]. Another concern regarding FSE with TSS, caused by the invasive nature of FSE, is the potential influence on hormonal production and fertility rate [26]. Therefore, the radiomics signature developed here may greatly benefit clinical decision-making by providing a noninvasive and quantitative method to differentiate between benign and malignant testicular masses.…”

Oncological and functional outcomes after testis-sparing surgery in patients with germ cell tumors: a systematic review of 285 cases

“…In patients with testicular tumors, TSS is currently only accepted as a treatment option in patients with interstitial cell tumors or suspected benign histologies, whereas high inguinal orchiectomy represents the standard of care in patients with tGCT [13,28,29]. This systematic review provides further data to discuss the risks and benefits of TSS in patients with tGCT and extends previous systematic reviews in two ways [30][31][32]. First, we only included tGCT patients to assess the oncological and functional outcomes in this specific group of patients, while previous publications included non-germ cell histologies.…”

Malignant testicular tumors in children: A single institution’s 12-year experience

“…Furthermore, FSE may improve the diagnostic accuracy, favoring an organ-sparing approach, especially in doubtful cases. [ 11 ]…”

“…Furthermore, FSE may improve the diagnostic accuracy, favoring an organ-sparing approach, especially in doubtful cases. [11] The treatment of testicular yolk sac tumors is dependent on tumor stage and patient age. Early-stage tumors fare better than late-stage tumors do.…”