Steiner Hannes, Höltl Lorenz, Maneschg Christoph, Berger Andreas P, Rogatsch Hermann, Bartsch Georg, Hobisch Alfred
Department of Urology, University of Innsbruck, Innsbruck, Austria.
Urology. 2003 Sep;62(3):508-13. doi: 10.1016/s0090-4295(03)00465-5.
To evaluate retrospectively the indications, surgical technique, feasibility, and follow-up data of our frozen section analysis-guided organ-sparing approach to small testicular tumors. Removal of a solitary testis or bilateral orchiectomy for testicular neoplasm results in androgen deprivation and infertility. Moreover, removal of a testis for benign lesions is to be avoided. Organ-sparing surgery aims at preserving enough testicular parenchyma to maintain physiologic endocrine function and, if possible, fertility.
Tumors of 25 mm or less in diameter were managed by an organ-sparing approach. Normal preoperative plasma levels of luteinizing hormone and testosterone were a prerequisite. After localization of the tumor by ultrasonography and accurate staging, organ-sparing surgery was performed under cold ischemia. Frozen section analyses of the tumor and tumor bed biopsies were obtained. In the case of malignant germ cell tumor with a normal contralateral testis, ablation of the tumor-bearing testis was performed.
A total of 32 organ-preserving procedures were performed in 30 patients without any complications. Local recurrence was observed in 1 patient who refused to undergo local radiotherapy for concomitant testicular intraepithelial neoplasia; repeat organ-sparing surgery was performed in this patient. After organ-sparing surgery, ablation of the remaining testis was performed in 1 patient because of positive margins on final histologic analysis and in another patient because of endocrine insufficiency. In all other patients, the serum testosterone levels remained within normal limits. No retroperitoneal, pulmonary, or other recurrences were encountered; all patients were free of disease at a mean follow-up of 46.3 months.
The organ-sparing frozen section analysis-guided approach to testicular masses represents a promising treatment alternative to orchiectomy in selected patients with bilateral malignant testicular tumors, tumors in a solitary testis, or unilateral or bilateral benign tumors. The technique is oncologically efficient, lifelong hormonal substitution can be prevented, and, in some patients, even fertility may be preserved, provided certain criteria concerning patient selection and surgical technique are observed.
回顾性评估我们采用冰冻切片分析指导的保留器官方法治疗小睾丸肿瘤的适应证、手术技术、可行性及随访数据。因睾丸肿瘤切除单个睾丸或双侧睾丸切除术会导致雄激素缺乏和不育。此外，应避免因良性病变而切除睾丸。保留器官手术旨在保留足够的睾丸实质以维持生理内分泌功能，并在可能的情况下保留生育能力。
直径25mm及以下的肿瘤采用保留器官方法治疗。术前黄体生成素和睾酮血浆水平正常是前提条件。通过超声定位肿瘤并准确分期后，在冷缺血状态下进行保留器官手术。获取肿瘤的冰冻切片分析及肿瘤床活检样本。对于对侧睾丸正常的恶性生殖细胞肿瘤患者，进行患侧睾丸切除。
30例患者共进行了32次保留器官手术，无任何并发症。1例患者因合并睾丸上皮内瘤变拒绝接受局部放疗而出现局部复发，该患者接受了再次保留器官手术。保留器官手术后，1例患者因最终组织学分析切缘阳性，另1例患者因内分泌功能不全，进行了对侧睾丸切除。所有其他患者的血清睾酮水平均保持在正常范围内。未出现腹膜后、肺部或其他复发情况；平均随访46.3个月时，所有患者均无疾病复发。
对于双侧恶性睾丸肿瘤、单个睾丸肿瘤或单侧或双侧良性肿瘤的特定患者，采用冰冻切片分析指导的保留器官方法治疗睾丸肿块是一种有前景的替代睾丸切除术的治疗方法。该技术在肿瘤学上有效，可避免终身激素替代治疗，并且在某些患者中，只要遵循有关患者选择和手术技术的特定标准，甚至可以保留生育能力。
