Giguere J K, Stablein D M, Spaulding J T, McLeod D G, Paulson D F, Weiss R B
Section of Medical Oncology, Walter Reed Army Medical Center, Washington, D.C. 20307.
J Urol. 1988 Jun;139(6):1225-8. doi: 10.1016/s0022-5347(17)42873-4.
Despite the clear indications for an inguinal approach, reports indicate that up to 53 per cent of all testicular tumors are diagnosed or initially treated in a manner inconsistent with the classical radical orchiectomy. Of 462 evaluable patients from the Testicular Cancer Intergroup Study 47 (10.2 per cent) had undergone a nonclassical orchiectomy as the initial surgical management. This group was analyzed separately to determine the prognostic significance of needle aspiration, open biopsy, a scrotal approach and tumor contamination. Within this group of patients, those who received no adjuvant chemotherapy exhibited no increase in local or distant recurrence. While the recurrence rate similarly was not adversely affected by even gross tumor contamination, this subset underwent significantly more aggressive local surgical salvage (p less than 0.01), with scrotectomy procedures found to be of probable therapeutic value. While not to be condoned, we conclude that deviations from the classical orchiectomy, when followed by appropriate surgical management and close observation, can be of little clinical impact.
尽管腹股沟入路有明确指征，但报告显示，高达53%的睾丸肿瘤在诊断或初始治疗时的方式与经典根治性睾丸切除术不一致。在睾丸癌国际协作组研究47的462例可评估患者中，47例（10.2%）最初的手术治疗采用了非经典睾丸切除术。对该组进行单独分析，以确定针吸活检、开放活检、阴囊入路和肿瘤污染的预后意义。在这组患者中，未接受辅助化疗的患者局部或远处复发率并未增加。虽然即使肿瘤明显污染，复发率同样也未受到不利影响，但该亚组接受了更积极的局部手术挽救（p<0.01），阴囊切除术被发现可能具有治疗价值。虽然这种做法不可取，但我们得出结论，在进行适当的手术处理和密切观察后，与经典睾丸切除术的偏差对临床影响可能很小。
