Testis-preserving surgery in bilateral testicular germ cell tumours (original) (raw)

1997, Journal of Pediatric Surgery

Objective To evaluate the indications, techniques and 14-163) and the 13 patients are currently free of disease; one patient had local recurrence 9 months outcome of organ-preserving tumour enucleation in patients with bilateral testicular germ cell tumours after tumour enucleation but after orchidectomy the patient is free of disease after a follow-up of 156 (BTGCT) rather than standard bilateral radical orchidectomy which results in loss of fertility and a lifelong months. Serum concentrations of luteinizing hormone and testosterone were within the normal range in all requirement for androgen replacement. Patients and methods In 13 patients with BTGCT of patients and no androgen substitution was necessary. A testicular biopsy taken 6 months post-operatively 6-30 mm in diameter, the tumours were enucleated under cold ischaemia after inguinal testicular explo-revealed Sertoli cells only in all patients who had received radiation therapy. ration, and biopsies of the tumour bed and the peripheral parenchyma were taken. Histology of the Conclusions These results suggest that organ-sparing surgery in patients with BTGCT represents a new orchidectomy specimen revealed a seminoma in four cases, an embryonal carcinoma in three, a teratocarci-therapeutic approach with endocrinological and psychological advantages. In our experience, enucle-noma and a mixed-germ cell tumour in two each, and a mature teratoma in one. Histology of the enucleated ation resection of testicular tumours is possible with certain prerequisites, i.e. the tumour is organ-confined tumours showed a seminoma in seven cases, an embryonal carcinoma in five and a mature teratoma with no infiltration of the rete testis, multiple biopsies of the tumour bed and peripheral parenchyma should in one. Six of the 13 patients underwent testicular radiation (20 Gy) for carcinoma in situ (CIS) and five be taken, any associated CIS treated by radiation therapy, and patients must be followed closely. patients had adjuvant local therapy. Six months postoperatively, a testicular biopsy was taken to determine Keywords Bilateral testicular cancer, bilateral germ cell tumour, tumour enucleation, organ-sparing surgery, the success of therapy. Results The median follow-up was 62 months (range follow-up improved dramatically during the last decade, with