OBJECTIVE: To determine the safety and efficacy of organ-sparing surgery (OSS) without ischemia in patients with testicular tumor. METHODS: From January 2003 to October 2010, marker-negative clinical stage I testicular tumors ≤ 30 mm and marker-positive tumors in case of a tumor in a singular testis were managed by an organ-sparing approach. After localization of the tumor by ultrasound and accurate staging, OSS was performed without ischemia. Frozen section analyses of the tumor and tumor bed biopsies were obtained. In cases of malignant germ cell tumor with a normal contralateral testis, an orchiectomy of the tumor-bearing testis was performed. In all other cases, the organ-preserving procedure was completed. RESULTS: A total of 65 patients underwent this approach. In 35 patients with a germ cell tumor on frozen section report (mean tumor size 1.4 cm; standard deviation ± 8.54 mm) and presence of a normal contralateral testis, a radical orchiectomy of the tumor-bearing testis was performed. Thirty-three organ-preserving procedures were completed in 30 patients without any complications (mean tumor size 0.9 cm; range, 0.2-2.0). No local or systemic recurrence was observed in all the 65 patients, and serum testosterone levels remained within normal limits in all but 2 patients. All patients are currently free of disease at a median follow-up of 52.5 months (range, 3-107). CONCLUSION: Our findings suggest that a "no-clamping" OSS technique is safe and feasible in selected tumor patients.
OBJECTIVE: To determine the safety and efficacy of organ-sparing surgery (OSS) without ischemia in patients with testicular tumor. METHODS: From January 2003 to October 2010, marker-negative clinical stage I testicular tumors ≤ 30 mm and marker-positive tumors in case of a tumor in a singular testis were managed by an organ-sparing approach. After localization of the tumor by ultrasound and accurate staging, OSS was performed without ischemia. Frozen section analyses of the tumor and tumor bed biopsies were obtained. In cases of malignant germ cell tumor with a normal contralateral testis, an orchiectomy of the tumor-bearing testis was performed. In all other cases, the organ-preserving procedure was completed. RESULTS: A total of 65 patients underwent this approach. In 35 patients with a germ cell tumor on frozen section report (mean tumor size 1.4 cm; standard deviation ± 8.54 mm) and presence of a normal contralateral testis, a radical orchiectomy of the tumor-bearing testis was performed. Thirty-three organ-preserving procedures were completed in 30 patients without any complications (mean tumor size 0.9 cm; range, 0.2-2.0). No local or systemic recurrence was observed in all the 65 patients, and serum testosterone levels remained within normal limits in all but 2 patients. All patients are currently free of disease at a median follow-up of 52.5 months (range, 3-107). CONCLUSION: Our findings suggest that a "no-clamping" OSS technique is safe and feasible in selected tumorpatients.
Authors: Jesse Ory; Udi Blankstein; Daniel C Gonzalez; Aditya A Sathe; Joshua T White; Carlos Delgado; John Reynolds; Keith Jarvi; Ranjith Ramasamy Journal: BJUI Compass Date: 2021-02-23