Subinguinal Orchidectomy for Testicular Cancer: Innovation or Unnecessary Advancement

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Subinguinal orchidectomy offers potential benefits by preserving the inguinal canal and ilioinguinal nerve.
• Concerns exist regarding residual disease in the proximal spermatic cord and its impact on testicular cancer outcomes.
• Evaluating the oncological safety and complication profile of subinguinal orchidectomy is crucial.

Purpose of the Study:

• To review and evaluate the oncological outcomes and complications associated with subinguinal orchidectomy.
• To compare subinguinal orchidectomy with the traditional high inguinal approach for testicular cancer treatment.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, Google Scholar, Cochrane Library, and Embase.
• Included studies compared inguinal versus subinguinal orchidectomies, reporting tumor grade, oncological outcomes, complications, and follow-up.
• Descriptive statistics were performed using Microsoft Excel.

Main Results:

• Two eligible studies with data from 264 patients (2000-2024) were reviewed; 54.7% underwent subinguinal orchidectomy.
• Unsatisfactory oncological control occurred in 12.5% of subinguinal cases, primarily due to cancer relapse (78%) or spermatic cord invasion (16.5%).
• No significant differences in oncological outcomes were found between subinguinal and high inguinal approaches for stage 1 and stage 2-4 cancers. Postoperative seromas occurred in 9.5% of subinguinal cases.

Conclusions:

• Current limited evidence suggests subinguinal orchidectomy has comparable oncological outcomes to the high inguinal approach.
• While retrospective data are supportive, prospective trials are necessary to definitively assess the risk-benefit ratio.
• Further research is needed to validate the safety and efficacy of subinguinal orchidectomy in testicular cancer management.