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Testis Sparing Surgery in Pediatric Testicular Tumors
Cezanne D Kooij1, Caroline C C Hulsker1, Mariëtte E G Kranendonk1
1Princess Máxima Center for Pediatric Oncology, 3584 Utrecht, The Netherlands.
Insights
Testis sparing surgery (TSS) is safe for pediatric patients under 12 with benign germ cell tumors and low-grade sex cord-stromal tumors. This approach avoids testicular atrophy and offers good outcomes for these specific pediatric testicular tumors.
Area of Science:
- Pediatric Urology
- Surgical Oncology
- Pediatric Oncology
Background:
- Testicular tumors are rare in children.
- Testis sparing surgery (TSS) is an alternative to radical orchiectomy.
- Evaluating TSS safety and outcomes in pediatric patients is crucial.
Purpose of the Study:
- To assess the outcomes of testis sparing surgery (TSS) in pediatric patients.
- To determine the conditions under which TSS is a safe treatment for pediatric testicular tumors.
Main Methods:
- A systematic literature search was conducted in Cochrane, PubMed, and Embase.
- Studies focused on TSS for pediatric testicular tumors, excluding reviews and case reports.
- Analysis included 20 studies encompassing 777 pediatric patients.
Main Results:
- TSS was used in 61.9% of benign germ cell tumors (GCTs) and 61.2% of sex cord-stromal tumors (SCSTs).
- No instances of testicular atrophy were reported.
- Recurrence occurred in 4 benign GCTs; none in SCSTs. TSS was rarely used for malignant GCTs (0.4%).
Conclusions:
- Testis sparing surgery (TSS) is a safe option for prepubertal patients (under 12) with benign GCTs.
- TSS is also a safe option for pediatric patients with low-grade SCSTs.
- Outcomes suggest TSS is a viable organ-preserving strategy for select pediatric testicular tumors.
Objective:
The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors.
Methods:
A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports.
Results:
Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%).
Conclusion:
TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.
