Buenos Aires, Argentina (UroToday.com) Sudhir Rawal, Professor Rajiv Ghandhi Cancer Institute and Research Center, India, discussed utilization of organ-sparing surgery in testicular cancer. Indications may include small non-nodular masses which majority of these lesions are benign (i.e adenomatoid tumors).
Contradictions include elevated STMS, retroperitoneal lesions and/or other findings suggestive more aggressive tumor. Imaging with scrotal u/s is standard with hypoechoic area confined to the testis is suggestive of testicular cancer. Frozen section with counseling possible radical orchiectomy and sperm banking are part of preoperative counseling. Strict surgical criteria include size limit 2cm, cold ischemia and biopsy of adjacent normal parenchyma to ensure negative surgical margin at time of surgery. False negative frozen is real with series up to 50% patients with negative frozen sections were positive for testicular cancer. These patients require delayed orchiectomy. Close follow-up is warranted in all patients. Complications are minimal and tumor seeding not a significant concern. At my institution, we reserve organ-sparing approach for extra testicular masses and recommend in patients with prior history testis cancer to preserve testosterone production and fertility weighing the risk of persistent disease and need for delayed therapy including radical orchiectomy.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.