Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study

Murat Keske, Abdullah Erdem Canda, Serdar Yalcin, Aydan Kilicarslan, Yusuf Kibar, Can Tuygun, Evrim Onder, Ali Fuat Atmaca, Asif Yildirim, Sidika Seyma Ozkanli, Olcay Kandemir, Taner Kargi, Mehmet Sar, Volkan Tugcu, Berkan Resorlu, Yilmaz Aslan, Selcuk Sarikaya, Ugur Boylu, Ali Fuat Cicek, Halil Basar, Altug Tuncel, Mevlana Derya Balbay

Abstract


Introduction: Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal- appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm.

Methods: In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0‒1 cm; n=35), Group 2 (1.1‒2 cm; n=99), and Group 3 (2.1‒3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups.

Results: Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p<0.05 between groups). TIN was detected in 20%, 42.4%, and 41.5% of Groups 1, 2, and 3, respectively (p<0.05 for Group 1 vs. Groups 2 and 3; p>0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p<0.05 for both Group 1 vs. Group3 and for Group 2 vs. Group 3; p>0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs.>1.5 cm (p>0.05).

Conclusions: Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.


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DOI: http://dx.doi.org/10.5489/cuaj.4016