Orchidectomy after primary chemotherapy for metastatic testicular cancer

To examine the outcome of orchidectomy following primary chemotherapy in patients with metastatic testicular cancer.

This was a retrospective analysis of patients who underwent primary chemotherapy without initial orchidectomy for testicular cancer between 1982 and 2006. The patients were identified from the regional oncology cancer database in our tertiary referral hospital. Their case notes were reviewed regarding initial presentation, chemotherapy, clinical progress and pathological outcomes following surgery.

21 evaluable patients were identified (14 non-seminomatous germ cell tumours, 7 seminomas). 16 patients underwent standard orchidectomy within 12 months of commencing chemotherapy and 5 patients underwent significantly delayed orchidectomy (19-68 months, mean 45.1 months). Orchidectomy in the standard group showed tumour necrosis or a scar in 13 patients (81%) and differentiated or mature teratoma in 3 patients associated with bulky poorly responsive retroperitoneal disease (19%). In the delayed orchidectomy group 3 out of 5 patients had viable seminoma, of which two were associated with carcinoma in situ.

Our study raises concerns as regards a potentially high risk of late tumour development in testes which are preserved following apparent tumour resolution after chemotherapy.