Radical inguinal orchiectomy for testicular germ cell tumors
- Graeme S Steele, MBBCh, FCS
Graeme S Steele, MBBCh, FCS
- Assistant Professor of Surgery
- Harvard Medical School
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Section Editor
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Professor of Medicine
- Harvard Medical School
- Chair, Executive Committee for Clinical Research
- Chief of the Division of Solid Tumor Oncology
- Director of the Lank Center for Genitourinary Oncology
- Dana Farber Cancer Institute
Testicular cancers, 95 percent of which are germ cell tumors, have become one of the most curable solid neoplasms because of remarkable treatment advances that began in the late 1970s. Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 and 34, and the five-year survival rate was 64 percent . Now, the five-year survival rate is over 95 percent for both seminoma and nonseminomatous germ cell tumors (NSGCTs) (table 1) , and testicular cancer is responsible for about 350 deaths annually in the United States .
These improvements in outcome are related to a better understanding of the natural history of testicular tumors, improved staging and surgical techniques, the use of tumor markers to guide patient management, and the introduction of effective platinum-based combination chemotherapy [1,4,5]. The consistently high cure rates in early-stage disease have resulted in a shift in focus toward reducing treatment-related effects on reproductive function, as well as the toxicities associated with chemotherapy and radiation. (See "Treatment-related toxicity in men with testicular germ cell tumors".)
Radical orchiectomy for the diagnosis and treatment of men with suspected testicular cancer is discussed here. An overview of the management of testicular cancer is presented separately. (See "Overview of the treatment of testicular germ cell tumors".)
SURGICAL TREATMENT OF THE TESTIS
The decision to proceed with operative intervention in a man with a suspected testicular cancer is made after careful consideration of all available data, including the clinical findings, imaging studies, and serum tumor markers. Although frequently used to support a clinical suspicion of testicular cancer, scrotal ultrasound of a testicular mass cannot replace surgical and histologic examination of the testis based upon radical inguinal orchiectomy. (See "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors".)
Radical inguinal orchiectomy — Radical inguinal orchiectomy with high ligation of the spermatic cord at the level of internal ring is the procedure of choice for suspected testicular cancer.
- Einhorn LH. Treatment of testicular cancer: a new and improved model. J Clin Oncol 1990; 8:1777.
- Ries LA, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975-2001, National Cancer Institute, Bethesda, MD, 2004 http://seer.cancer.gov/csr/1975_2007/index.html (Accessed on April 11, 2011).
- Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.
- Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med 1997; 337:242.
- Levin HS. Prognostic features of primary and metastatic testis germ-cell tumors. Urol Clin North Am 1993; 20:39.
- Adshead J, Khoubehi B, Wood J, Rustin G. Testicular implants and patient satisfaction: a questionnaire-based study of men after orchidectomy for testicular cancer. BJU Int 2001; 88:559.
- Turek PJ, Master VA, Testicular Prosthesis Study Group. Safety and effectiveness of a new saline filled testicular prosthesis. J Urol 2004; 172:1427.
- Yossepowitch O, Aviv D, Wainchwaig L, Baniel J. Testicular prostheses for testis cancer survivors: patient perspectives and predictors of long-term satisfaction. J Urol 2011; 186:2249.
- Leibovitch I, Little JS Jr, Foster RS, et al. Delayed orchiectomy after chemotherapy for metastatic nonseminomatous germ cell tumors. J Urol 1996; 155:952.
- Simmonds PD, Mead GM, Lee AH, et al. Orchiectomy after chemotherapy in patients with metastatic testicular cancer. Is it indicated? Cancer 1995; 75:1018.
- Greist A, Einhorn LH, Williams SD, et al. Pathologic findings at orchiectomy following chemotherapy for disseminated testicular cancer. J Clin Oncol 1984; 2:1025.
- Ondrus D, Hornák M, Breza J, et al. Delayed orchiectomy after chemotherapy in patients with advanced testicular cancer. Int Urol Nephrol 2001; 32:665.
- Ramani VA, Grey BR, Addla SK, et al. Histological outcome of delayed orchidectomy after primary chemotherapy for metastatic germ cell tumour of the testis. Clin Oncol (R Coll Radiol) 2008; 20:247.
- Geldart TR, Simmonds PD, Mead GM. Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer. BJU Int 2002; 90:451.
- Chong C, Logothetis CJ, von Eschenbach A, et al. Orchiectomy in advanced germ cell cancer following intensive chemotherapy: a comparison of systemic to testicular response. J Urol 1986; 136:1221.
- Giguere JK, Stablein DM, Spaulding JT, et al. The clinical significance of unconventional orchiectomy approaches in testicular cancer: a report from the Testicular Cancer Intergroup Study. J Urol 1988; 139:1225.
- Capelouto CC, Clark PE, Ransil BJ, Loughlin KR. A review of scrotal violation in testicular cancer: is adjuvant local therapy necessary? J Urol 1995; 153:981.
- Pizzocaro G, Zanoni F, Salvioni R, et al. Difficulties of a surveillance study omitting retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 1987; 138:1393.
- Kennedy CL, Hendry WF, Peckham MJ. The significance of scrotal interference in stage I testicular cancer managed by orchiectomy and surveillance. Br J Urol 1986; 58:705.
- Thomas GM, Sturgeon JF, Alison R, et al. A study of post-orchiectomy surveillance in stage I testicular seminoma. J Urol 1989; 142:313.
- Heidenreich A, Höltl W, Albrecht W, et al. Testis-preserving surgery in bilateral testicular germ cell tumours. Br J Urol 1997; 79:253.
- Yossepowitch O, Baniel J. Role of organ-sparing surgery in germ cell tumors of the testis. Urology 2004; 63:421.
- Schmoll HJ, Souchon R, Krege S, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15:1377.
- Sonneveld DJ, Schraffordt Koops H, Sleijfer DT, Hoekstra HJ. Bilateral testicular germ cell tumours in patients with initial stage I disease: prevalence and prognosis--a single centre's 30 years' experience. Eur J Cancer 1998; 34:1363.
- Holzbeierlein JM, Sogani PC, Sheinfeld J. Histology and clinical outcomes in patients with bilateral testicular germ cell tumors: the Memorial Sloan Kettering Cancer Center experience 1950 to 2001. J Urol 2003; 169:2122.
- Che M, Tamboli P, Ro JY, et al. Bilateral testicular germ cell tumors: twenty-year experience at M. D. Anderson Cancer Center. Cancer 2002; 95:1228.
- Dieckmann KP, Skakkebaek NE. Carcinoma in situ of the testis: review of biological and clinical features. Int J Cancer 1999; 83:815.
- Connolly SS, D'Arcy FT, Bredin HC, et al. Value of frozen section analysis with suspected testicular malignancy. Urology 2006; 67:162.
- Heidenreich A, Weissbach L, Höltl W, et al. Organ sparing surgery for malignant germ cell tumor of the testis. J Urol 2001; 166:2161.