TESTIS-PRESERVING SURGERY IN BILATERAL TESTICULAR GERM-CELL TUMORS

Objective To evaluate the indications, techniques and outcome of organ -preserving tumour enucleation in patients with bilateral testicular g erm cell tumours (BTGCT) rather than standard bilateral radical orchid ectomy which results in loss of fertility and a lifelong requirement f or androgen replacement, Patients and methods In 13 patients with BTGC T of 6-30 mm in diameter, the tumours were enucleated under cold ischa emia after inguinal testicular exploration, and biopsies of the tumour bed and the peripheral parenchyma were taken. Histology of the orchid ectomy specimen revealed a seminoma in four cases, an embryonal carcin oma in three, a teratocarcinoma and a mixed-germ cell tumour in two ea ch, and a mature teratoma in one. Histology of the enucleated tumours showed a seminoma in seven cases, an embryonal carcinoma in five and a mature teratoma in one. Six of the 13 patients underwent testicular r adiation (20 Gy) for carcinoma in situ (CIS) and five patients had adj uvant local therapy. Six months post-operatively, a testicular biopsy was taken to determine the success of therapy. Results The median foll ow-up was 62 months (range 14-163) and the 13 patients are currently f ree of disease; one patient had local recurrence 9 months after tumour enucleation but after orchidectomy the patient is free of disease aft er a follow-up of 156 months. Serum concentrations of luteinizing horm one and testosterone were within the normal range in all patients and no androgen substitution was necessary, A testicular biopsy taken 6 mo nths post-operatively revealed Sertoli cells only in all patients who had received radiation therapy. Conclusions These results suggest that organ-sparing surgery in patients with BTGCT represents a new therape utic approach with endocrinological and psychological advantages. In o ur experience, enucleation resection of testicular tumours is possible with certain prerequisites, i.e. the tumour is organ-confined with no infiltration of the rete testis, multiple biopsies of the tumour bed and peripheral parenchyma should be taken, any associated CIS treated by radiation therapy, and patients must be followed closely.