Testis-sparing surgery for testicular tumors in children: a 20 year single center experience and systematic review of the literature

Abstract

Purpose

Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed. This study herein reports a 20 year single center experience applying testicular sparing surgery (TSS) as a primary operative strategy in pediatric patients. A systematic literature review summarizes the utility and outcomes of TSS in appropriately selected patients.

Methods

Pediatric patients with TT who underwent TSS between 1997 and 2018 were studied. TSS was indicated if patients presented evidence of adequately spared healthy testicular parenchyma on preoperative ultrasound and negative serum tumor markers. A systematic review of the literature was also performed.

Results

12 cases met full inclusion criteria with 10 of 12 subjects in the prepubertal age group. Follow-up was 73 months (range 18–278 months). Only a single male patient (GSCCT) presented with early recurrence and orchidectomy was then performed. No cases of postoperative testicular atrophy were identified. Sexual maturation (Tanner stage) expected for age in each patient was documented. Review of the literature identified 34 published studies including 269 patients (94% prepubertal). Pathologic lesions here were mainly mature teratoma(s)—(62%) with a follow-up period of 4 years. Recurrent tumors were observed in only three patients (1.1%) notably two Leydig Cell Tumors and one Teratoma. Testicular atrophy reportedly occurred in only one single case (0.37%).

Discussion

TSS is a feasible alternative to radical orchidectomy in pediatric male patients with localized TT and negative tumor markers. Long term follow-up is essential to monitor testicular growth, puberty with sexual development and psychological male health.

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Abbreviations

TT:

Testicular tumors

TSS:

Testicular sparing surgery

GSCCT:

Giant Sertoli cell calcifying tumor

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Authors

Contributions

All authors contributed to the study conception and design. Study design, data collection and analysis were performed by JIB, RLV and PAL. The first draft of the manuscript was written by JIB, PDL and PAL and all authors subsequently revised, drafted, edited and approved the final manuscript.

Corresponding author

Correspondence to Pablo A. Lobos.

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The authors declare that they have no conflict of interest.

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This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) approved this study.

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Annex

Annex

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((‘testis sparing surgery’/exp OR ‘partial orchiectomy’:ti,ad OR ‘parenchymal surgery’:ti,ab) AND (‘testis tumor’/exp OR ‘testicular tumor’:ti,ab)) AND ([adolescent]/lim OR [child]/lim OR [infant]/lim OR [preschool]/lim OR [school]/lim)

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Bois, J.I., Vagni, R.L., de Badiola, F.I. et al. Testis-sparing surgery for testicular tumors in children: a 20 year single center experience and systematic review of the literature. Pediatr Surg Int 37, 607–616 (2021). https://doi.org/10.1007/s00383-020-04850-6

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Keywords

  • Testicular tumor
  • Testis-sparing surgery
  • Pediatric tumors
  • Germ cell tumors