Document Detail


Frozen section analysis-guided organ-sparing approach in testicular tumors: technique, feasibility, and long-term results.
MedLine Citation:
PMID:  12946756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate retrospectively the indications, surgical technique, feasibility, and follow-up data of our frozen section analysis-guided organ-sparing approach to small testicular tumors. Removal of a solitary testis or bilateral orchiectomy for testicular neoplasm results in androgen deprivation and infertility. Moreover, removal of a testis for benign lesions is to be avoided. Organ-sparing surgery aims at preserving enough testicular parenchyma to maintain physiologic endocrine function and, if possible, fertility. METHODS: Tumors of 25 mm or less in diameter were managed by an organ-sparing approach. Normal preoperative plasma levels of luteinizing hormone and testosterone were a prerequisite. After localization of the tumor by ultrasonography and accurate staging, organ-sparing surgery was performed under cold ischemia. Frozen section analyses of the tumor and tumor bed biopsies were obtained. In the case of malignant germ cell tumor with a normal contralateral testis, ablation of the tumor-bearing testis was performed. RESULTS: A total of 32 organ-preserving procedures were performed in 30 patients without any complications. Local recurrence was observed in 1 patient who refused to undergo local radiotherapy for concomitant testicular intraepithelial neoplasia; repeat organ-sparing surgery was performed in this patient. After organ-sparing surgery, ablation of the remaining testis was performed in 1 patient because of positive margins on final histologic analysis and in another patient because of endocrine insufficiency. In all other patients, the serum testosterone levels remained within normal limits. No retroperitoneal, pulmonary, or other recurrences were encountered; all patients were free of disease at a mean follow-up of 46.3 months. CONCLUSIONS: The organ-sparing frozen section analysis-guided approach to testicular masses represents a promising treatment alternative to orchiectomy in selected patients with bilateral malignant testicular tumors, tumors in a solitary testis, or unilateral or bilateral benign tumors. The technique is oncologically efficient, lifelong hormonal substitution can be prevented, and, in some patients, even fertility may be preserved, provided certain criteria concerning patient selection and surgical technique are observed.
Authors:
Hannes Steiner; Lorenz Höltl; Christoph Maneschg; Andreas P Berger; Hermann Rogatsch; Georg Bartsch; Alfred Hobisch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Urology     Volume:  62     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-08-29     Completed Date:  2003-10-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  508-13     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Innsbruck, Innsbruck, Austria.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Disease-Free Survival
Feasibility Studies
Follow-Up Studies
Frozen Sections / methods*
Germinoma / pathology,  radiotherapy,  surgery
Humans
Infant
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasms, Second Primary / pathology,  radiotherapy,  surgery
Preoperative Care
Radiotherapy, Adjuvant
Retrospective Studies
Teratoma / pathology,  radiotherapy,  surgery
Testicular Neoplasms / pathology*,  radiotherapy,  surgery*

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