Presentation Authors: Gregory Nason*, Lynn Anson-Cartwright, Michael Jewett, Martin O'Malley, Joan Sweet, Robert Hamilton, Toronto, Canada
Introduction: Radical orchiectomy (RO) is the gold standard treatment for a suspicious testicular lesion. Organ sparing surgery can be considered in the setting of a solitary functioning testis or bilateral tumors. It has also been suggested as an alternative to radical orchiectomy for small lesions. The aim of this study was to report the experience of partial orchiectomy (PO) at our centre.
Methods: We performed a retrospective review of our prospectively maintained testicular cancer database at the Princess Margaret Cancer Centre analyzing PO.
Results: A total of 77 patients underwent a PO between 1983 and 2018. The mean age was 31.3 years (range 17-56 years). A lesion was palpable in 70 (90.9%) patients. The mean size of lesion was 14.1mm (Range 3-35mm). 39 (50.6%) patients underwent a PO due a small lesion, 30 (39%) to a solitary functioning testis, 6 (7.8%) due to bilateral lesions, 1 (1.3%) for an assumed benign lesion and 1 (1.3%) was not documented. The mean follow up was 55 months (Range 1-258).Histological analysis revealed a benign lesion in 25 (32.5%) patients. A positive surgical margin was noted in 6 patients (7.8%). None of these patents developed a local or distant recurrence. 16 (20.8%) patients subsequently had a RO following an initial PO at a mean interval of 9.8 months (Range 0-46 months). The reasons for subsequent RO included a radiologically detected lesion in 7 patients, a palpable lesion in 4 patients, a positive surgical margin in 3 patients and a pathological finding in 2 patients. Malignant histology was present in 12 (75%) of the RO specimens.Of the patients who initially presented with no metastatic disease (n=57), 7 (12.3%) patients subsequently developed a nodal recurrence. None of these had a positive margin at PO. All were salvaged with adjuvant treatment and are currently disease free. There have been two disease-specific deaths in the series- both, however, initially presented with widespread metastatic disease. There were no reported Clavien-Dindo Grade 3-5 complications.
Conclusions: Organ sparing surgery is a safe and feasible approach to small testicular lesions. A proportion of small testicular lesions are benign and it can potentially avoid the necessity for a radical orchiectomy.