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Frozen section analysis-guided organ-sparing approach in testicular tumors: technique, feasibility, and long-term results.

机译:冷冻切片分析指导睾丸肿瘤的器官保留方法:技术,可行性和长期结果。

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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.
机译:目的:回顾性评估我们冷冻切片分析指导的保留小睾丸肿瘤的器官保存方法的适应症,手术技术,可行性和随访数据。睾丸肿瘤切除一个单独的睾丸或双侧睾丸切除术会导致雄激素剥夺和不育。此外,应避免切除良性病变的睾丸。保留器官的手术旨在保留足够的睾丸实质,以维持生理内分泌功能以及可能的生育能力。方法:采用保留器官的方法处理直径小于等于25 mm的肿瘤。术前促黄体激素和睾丸激素水平正常是先决条件。通过超声检查定位肿瘤并精确分期后,在冷缺血下进行保留器官的手术。获得肿瘤的冷冻切片分析和肿瘤床活检。对于具有正常对侧睾丸的恶性生殖细胞肿瘤,进行消融肿瘤的睾丸。结果:30例患者共进行了32次器官保留手术,无任何并发症。 1例因睾丸上皮内瘤样变而拒绝接受局部放疗的患者中观察到局部复发;该患者进行了重复的器官保留手术。保留器官的手术后,由于最终组织学分析的切缘阳性,在一名患者中切除了剩余的睾丸,而在另一名患者中由于内分泌功能不全而进行了消融。在所有其他患者中,血清睾丸激素水平保持在正常范围内。没有遇到腹膜后,肺或其他复发;所有患者均无疾病,平均随访46.3个月。结论:针对双侧睾丸恶性肿瘤,单发睾丸肿瘤,单侧或双侧良性肿瘤的部分患者,保留器官的冷冻切片分析指导方法可替代睾丸切除术。该技术在肿瘤学上是有效的,可以预防终身荷尔蒙替代,并且在某些患者中,只要遵守有关患者选择和手术技术的某些标准,甚至可以保留生育力。

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