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Organ preservation technique without ischemia in patients with testicular tumor
Nicolai Leonhartsberger1, Renate Pichler1, Brigitte Stoehr1
1Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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.
Insights
Organ-sparing surgery (OSS) without ischemia is safe and effective for selected testicular tumor patients. This approach demonstrated no recurrence and preserved testosterone levels in most patients, indicating feasibility.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Testicular tumors require careful management to balance oncological outcomes and testicular function.
- Organ-sparing surgery (OSS) is an alternative to radical orchiectomy for selected cases.
- Minimizing ischemia during OSS is crucial for preserving testicular viability.
Purpose of the Study:
- To evaluate the safety and efficacy of a "no-clamping" organ-sparing surgery (OSS) technique for testicular tumors.
- To assess oncological outcomes and hormonal function following OSS without ischemia.
Main Methods:
- A cohort of 65 patients with clinical stage I testicular tumors underwent OSS without ischemia between 2003 and 2010.
- Tumor localization via ultrasound, staging, and frozen section analysis were performed.
- Organ-preserving procedures were completed in 30 patients; radical orchiectomy was performed in 35 patients with malignant germ cell tumors and a normal contralateral testis.
Main Results:
- Thirty-three organ-preserving procedures were successfully completed in 30 patients without complications.
- No local or systemic recurrence was observed in any of the 65 patients.
- Serum testosterone levels remained normal in all but two patients, with a median follow-up of 52.5 months.
Conclusions:
- The "no-clamping" organ-sparing surgery (OSS) technique is a safe and feasible option for selected patients with testicular tumors.
- This approach effectively preserves testicular function and achieves excellent oncological control.
