Department of Urology, University Hospital Limerick, Limerick, Ireland.
Urologia. 2020 May;87(2):70-74. doi: 10.1177/0391560319840529. Epub 2019 Apr 16.
Radical inguinal orchidectomy with ligation and division of the spermatic cord at the deep inguinal ring is the treatment of choice for testicular mass suspicious of cancer. In the era of organ preserving and minimally invasive surgery, it may be possible to propose a less radical sub-inguinal orchidectomy that may avoid the morbidity associated with opening the inguinal canal. The effect of this approach on oncological margins is not known. The aim of this article was to investigate the presence of spermatic cord involvement after a radical inguinal orchidectomy with a view to test feasibility of a modified sub-inguinal approach for testicular tumour excision.
A retrospective study on all orchidectomies performed for suspected testicular cancer was performed at a single hospital from over an 8-year period from January 2005 to December 2013. Non-cancerous lesions were excluded after histopathological review. All testicular malignancies were included and detailed histopathological review was performed.
A total of 121 orchidectomies were performed over the 8-year period. Three patients had spermatic cord involvement. Spermatic cord involvement did not adversely affect the outcome in these patients after a median follow-up of 5 years irrespective of tumour histology. The proximal spermatic cord was not involved in any testicular germ cell tumours on further cord sectioning, the only patient with proximal cord involvement had a B-cell lymphoma.
We postulate that a sub-inguinal modified orchidectomy may be a less invasive alternative to radical inguinal orchidectomy, with comparable oncological outcomes based on low risk of spermatic cord involvement, which in itself is not a prognostic factor. We require further long-term follow-up studies on patients who have undergone this approach to validate the oncological outcomes and report the possible advantage of lower post-operative complications with this technique.
根治性腹股沟睾丸切除术联合精索在腹股沟深环处结扎和切断，是治疗疑似癌症的睾丸肿块的首选方法。在保留器官和微创手术的时代，有可能提出一种不太激进的精索下睾丸切除术，从而避免与开放腹股沟管相关的发病率。但这种方法对肿瘤切缘的影响尚不清楚。本文旨在研究根治性腹股沟睾丸切除术后精索的受累情况，以期探讨改良精索下方法切除睾丸肿瘤的可行性。
在一家医院进行了一项回顾性研究，对 2005 年 1 月至 2013 年 12 月 8 年间所有疑似睾丸癌行睾丸切除术的患者进行了研究。组织病理学检查排除了非癌性病变。所有睾丸恶性肿瘤均被纳入，并进行了详细的组织病理学检查。
在 8 年期间共进行了 121 例睾丸切除术。3 例患者精索受累。在中位随访 5 年后，无论肿瘤组织学类型如何，这些患者的预后均未受影响。进一步对精索进行分段，发现近端精索未受累于任何睾丸生殖细胞肿瘤，唯一近端精索受累的患者患有 B 细胞淋巴瘤。
我们推测，精索下改良睾丸切除术可能是一种比根治性腹股沟睾丸切除术创伤更小的替代方法，基于精索受累的低风险，具有相似的肿瘤学结果，而精索受累本身并不是预后因素。我们需要对接受这种方法的患者进行进一步的长期随访研究，以验证肿瘤学结果，并报告该技术可能具有较低的术后并发症优势。
