Partial orchiectomy vs. radical orchiectomy for pediatric testis tumors

Abstract

While radical orchiectomy remains the gold standard for testicular cancer, partial orchiectomy has become a well-accepted organ-sparing approach for benign testicular tumors in pre-pubertal patients.The aims of testicular-sparing surgery include prevention of over-treatment, preservation of future hormonal and reproductive function, and provision of a durable cure. For pre-pubertal patients, who have a high likelihood of benign lesions, partial orchiectomy provides effective treatment, owing to the high reliability of scrotal ultrasound (US) and intraoperative frozen section. In adolescent and young adult patients, who are more likely to harbor malignant pathology, the role of partial orchiectomy is less clear. Testis-sparing surgery is being reported with greater frequency in the adult literature for small testicular masses and for situations in which radical orchiectomy would result in an anorchia. More recently, a testis-sparing approach has also been described for carefully-selected post-pubertal pediatric patients. This review will highlight the role of partial orchiectomy in pediatric patients (<18 years old).

Imaging sub-diffuse optical properties of cancerous and normal skin tissue using machine learning-aided spatial frequency domain imaging

“… 62 Additionally, this work may be more difficult to incorporate for cancers for which tissue-conserving surgery is generally not considered a gold standard, such as with testicular cancer. 63 …”

Organ Sparing Surgery in Testicular Cancer

“…However, pediatric patients are also at risk of developing testicular tumors, though they are rare, only accounting for 1-2% of all childhood tumors (18). The majority of these are benign, with teratoma being the most common type (19). Teratomas in pre-pubertal boys act in a benign way, unlike in the adult population and are not associated with CIS (20).…”

“…Teratomas in pre-pubertal boys act in a benign way, unlike in the adult population and are not associated with CIS (20). The most common malignant tumor in the pre-pubertal pediatric patient is a yolk sac tumor, 90% of which will have an elevated alpha fetoprotein level which makes it a very sensitive diagnostic test for these tumors (19). The post-pubertal patients are more likely to have a malignant tumor and therefore OSS is not recommended in this cohort.…”

“…OSS in the pediatric population is lacking long-term follow-up data, and therefore any divergence from the guidelines should be taken with caution. If OSS is performed for benign tumors, it should be done using intraoperative frozen section as this is proven to correlate well with final histology (19).…”