Jacob Dayan, Chitteti Pragnitha, Mubarak Mohamed, Nadeem Mehwash
Urology, James Cook University Hospital, Middlesbrough, GBR.
Cureus. 2025 Jun 15;17(6):e86062. doi: 10.7759/cureus.86062. eCollection 2025 Jun.
Subinguinal orchidectomy is a variation of the traditional high inguinal approach for testicular cancer, differing in the level of spermatic cord excision. While the subinguinal approach preserves the inguinal canal and ilioinguinal nerve, concerns remain about the residual disease in the proximal cord and its impact on oncological outcomes. This review evaluates oncological outcomes and complications of subinguinal orchidectomy. A search was conducted across five databases (PubMed, Scopus, Google Scholar, Cochrane Library, and Embase). Studies reporting inguinal versus subinguinal orchidectomies, tumor grade, oncological outcomes, complications, and follow-up were included. Descriptive statistics were performed using Microsoft Excel (Microsoft Corporation, Redmond, WA). Of the 25 studies screened, two were eligible for review, including data from 264 patients (2000-2024). Subinguinal orchidectomy was done in 54.7% (n=144) of cases. Unsatisfactory oncological control was observed in 12.5% (n=18) of subinguinal cases, with 78% (n=14) due to cancer relapse, 16.5% (n=3) due to spermatic cord invasion (SCI), and 5.5% (n=1) due to positive margins. One study comparing subinguinal and high inguinal approaches found no differences in oncological outcomes for stage 1 and stage 2-4 cancers (p=0.91 and p=0.78, respectively). One study reported that 9.5% of patients who underwent subinguinal orchidectomy (n=4) developed seromas postoperatively. Current evidence, though limited, suggests no significant differences in oncological outcomes between subinguinal and high-inguinal orchidectomies. While retrospective studies support this, prospective trials are required to better evaluate the oncological risk-benefit ratio of subinguinal orchidectomy.
腹股沟下睾丸切除术是睾丸癌传统高位腹股沟入路的一种变体，在精索切除水平上有所不同。虽然腹股沟下入路保留了腹股沟管和髂腹股沟神经，但近端精索的残留疾病及其对肿瘤学结局的影响仍令人担忧。本综述评估腹股沟下睾丸切除术的肿瘤学结局和并发症。在五个数据库（PubMed、Scopus、谷歌学术、考克兰图书馆和Embase）中进行了检索。纳入了报告腹股沟与腹股沟下睾丸切除术、肿瘤分级、肿瘤学结局、并发症和随访情况的研究。使用微软Excel（微软公司，华盛顿州雷德蒙德）进行描述性统计。在筛选的25项研究中，两项符合综述条件，包括来自264例患者（2000 - 2024年）的数据。54.7%（n = 144）的病例采用了腹股沟下睾丸切除术。在腹股沟下手术病例中，12.5%（n = 18）观察到肿瘤学控制不令人满意，其中78%（n = 14）是由于癌症复发，16.5%（n = 3）是由于精索侵犯（SCI），5.5%（n = 1）是由于切缘阳性。一项比较腹股沟下和高位腹股沟入路的研究发现，1期和2 - 4期癌症的肿瘤学结局无差异（分别为p = 0.91和p = 0.78）。一项研究报告称，接受腹股沟下睾丸切除术的患者中有9.5%（n = 4）术后出现血清肿。现有证据虽然有限，但表明腹股沟下和高位腹股沟睾丸切除术在肿瘤学结局方面无显著差异。虽然回顾性研究支持这一点，但需要前瞻性试验来更好地评估腹股沟下睾丸切除术的肿瘤学风险效益比。
