Keske Murat, Canda Abdullah Erdem, Atmaca Ali Fuat, Cakici Ozer Ural, Arslan Muhammed Ersagun, Kamaci Davut, Balbay Mevlana Derya
University of Health Sciences, Kayseri Training and Research Hospital, Department of Urology, Kayseri, Turkey.
Koc University, School of Medicine, Department of Urology, Istanbul, Turkey.
Can Urol Assoc J. 2019 Mar;13(3):E83-E88. doi: 10.5489/cuaj.5379. Epub 2018 Aug 30.
We present oncological and functional outcomes of patients who underwent testis-sparing surgery (TSS).
Overall, 13 patients were included. Mean patient age was 29.9±12.5 years. In five patients, TSS was performed for sequential bilateral testicular tumours. One patient underwent concurrent left radical orchiectomy and right TSS. In eight patients with normal contralateral testis, seven underwent left and one underwent right TSS.
Mean pathological tumour size was 14.6±12.5 mm. Intraoperative frozen section evaluation of the mass was performed in eight patients that revealed benign lesions. No intraoperative tumour bed biopsies were taken in this patient group. Regarding the remaining five patients, intraoperative tumour bed biopsies were taken and testicular intraepithelial neoplasia (TIN) was reported in two (40%) patients; no local testicular radiotherapy was given postoperatively. Tumour pathology was malignant in all but one lesion, including Leydig cell tumour (n=1), seminoma(n=2), embryonal carcinoma (n=1), and adenomatoid tumour (n=1). During 47.2±22.5 months of followup, local recurrence was detected in one patient who underwent radical orchiectomy. No additional local recurrence or systemic metastasis was identified in other patients with malignant lesions. For patients with malignant tumours, of the three patients with a normal preoperative testosterone levels, testosterone level was normal in one patient (with no erectile dysfunction [ED]) and was decreased in two patients (with ED) following TSS. No ED was reported in the nine patients with benign lesions.
In carefully selected cases, TSS appears to be a safe, feasible procedure with adequate cancer control that could preserve sexual function.
我们展示了接受保留睾丸手术（TSS）患者的肿瘤学和功能结果。
总共纳入了13例患者。患者平均年龄为29.9±12.5岁。5例患者因双侧睾丸肿瘤先后接受了TSS。1例患者同时接受了左侧根治性睾丸切除术和右侧TSS。在8例对侧睾丸正常的患者中，7例接受了左侧TSS，1例接受了右侧TSS。
肿瘤平均病理大小为14.6±12.5毫米。8例患者术中对肿块进行了冰冻切片评估，结果显示为良性病变。该患者组未进行术中肿瘤床活检。对于其余5例患者，进行了术中肿瘤床活检，2例（40%）患者报告有睾丸上皮内瘤变（TIN）；术后未给予局部睾丸放疗。除1个病变外，所有肿瘤病理均为恶性，包括间质细胞瘤（n = 1）、精原细胞瘤（n = 2）、胚胎癌（n = 1）和腺瘤样瘤（n = 1）。在47.2±22.5个月的随访期间，1例接受根治性睾丸切除术的患者出现局部复发。其他恶性病变患者未发现额外的局部复发或全身转移。对于患有恶性肿瘤的患者，术前睾酮水平正常的3例患者中，1例患者（无勃起功能障碍[ED]）术后睾酮水平正常，2例患者（有ED）术后睾酮水平降低。9例良性病变患者均未报告有ED。
在经过精心挑选的病例中，TSS似乎是一种安全、可行的手术，能够充分控制癌症并保留性功能。
