Abstract
Purpose
The aim of the present study was to evaluate evolution of conservative echo-guided surgery for testicular tumours ≤1.5 cm and to assess the safety of this surgical procedure.
Methods
49 consecutive patients diagnosed with ultrasonography testicular lesions (mono or bilateral) ≤1.5 cm and treated with conservative echo-guided testicular surgery were examined. The parameters considered in this retrospective analysis included case history, physical examination, scrotal and abdominal ultrasonography, computed tomography scan, size of the nodule (maximum diameter), tumour markers, chest radiography, frozen section examination, histologic size of the tumour, overall survival (OS) and findings on follow-up.
Results
Mean age of patients was 33 years (range 18–62). Patients who presented with a palpable testicular nodule were 32.7 %, gynecomastia 10.2 %, precocious pseudopuberty 4 %, and scrotal pain 12.2 %. Permanent section examination confirmed the FSE data in all cases of certainty malignant lesion and definitive histological types were: 22 seminoma, 13 non-seminomatous or mixed germ cell tumours, 4 Leydig tumours, 2 hamartoma, 1 epidermoid cyst, 2 sertoli cell tumours, and 5 fibrous pseudotumour. No complications intra- and postoperative were observed. Overall survival was 100 % and scrotal US showed evidence of local tumour recurrence in 6 patients (12.2 %) after a mean follow-up of 34.7 months.
Conclusion
The OS, the low rate of local recurrence, and absence of complications, tend to demonstrate the safety of the procedure. The benefits to testicular-sparing surgery include improving the patient’s overall quality of life, fertility, endocrine function and negative cosmetic effects of radical orchiectomy.
Riassunto
Scopo del lavoro
Lo scopo del presente studio è stato quello di valutare il ruolo della terapia chirurgia ecoguidata conservativa nel trattamento dei tumori testicolari ≤1.5 cm e valutarne la sicurezza ed efficacia.
Metodi
Furono esaminati 49 pazienti con diagnosi ecografica di lesione testicolare (mono o bilaterale) ≤1.5 cm e sottoposti a chirurgia testicolare conservativa ecoguidata. I parametri presi in considerazione in questo studio retrospettivo furono la storia clinica del paziente, l’esame obiettivo, l’ecografia scrotale ed addominale, la TAC, le dimensioni della lesione, i marcatori tumorali, la radiografia del torace, l’esame istologico estemporaneo e definitivo della lesione, il tasso di sopravvivenza globale e i risultati del follow-up.
Risultati
L’età media dei pazienti è stata di 33 anni (range 18–62). Il 32.7 % dei pazienti presentavano un nodulo testicolare apprezzabile palpatoriamente, il 10.2 % ginecomastia, il 4 % pseudopubertà precoce, mentre il 12.2 % dolore scrotale. In tutti i casi l’esame istologico definitivo delle lesioni tumorali aveva confermato i risultati riscontrati all’esame istologico estemporaneo. Gli istotipi definitivi furono: 22 tumori seminomatosi, 13 non seminomatosi o a cellule germinali miste, 4 tumori a cellule di Leydig, 2 amartomi, 1 cisti epidermoide, 2 tumori a cellule del Sertoli e 5 psudotumori con componente fibrosa. Non sono state riscontrate in tutti i casi complicanze intra e post-operatorie. Il tasso di sopravvivenza è stato del 100 %, in 6 pazienti (12.2 %) è stata riscontrata una recidiva locale al controllo ecografico scrotale dopo un follow-up medio di circa 34.7 mesi.
Conclusioni
Il tasso di sopravvivenza elevato, il basso tasso di recidiva locale della malattia e la completa assenza di complicazioni, dimostrano la sicurezza della procedura praticata. I vantaggi della chirurgia testicolare conservativa comprendono il miglioramento della qualità complessiva di vita del paziente in termini di fertilità, miglioramento della funzionalità endocrina e di estetica legati all’orchiectomia demolitiva.
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Conflict of interest
Lucio Dell’Atti declares no conflict of interest.
Informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent for enrolment in the study and the inclusion in this article of information that could potentially lead to their identification.
Human and animal studies
The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.
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Dell’Atti, L. Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses. J Ultrasound 19, 29–33 (2016). https://doi.org/10.1007/s40477-015-0171-4
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DOI: https://doi.org/10.1007/s40477-015-0171-4