gms | German Medical Science

Objectives: evaluation of indication, techniques and outcome of organ preserving tumor enucleation in patients with meatchronous/synchronous bilateral testicular germ cell tumors (TGCT) or TGCT in a solitary testicle. The longterm data of 101 patients are presented.

Patients & Methods: Tumor enucleation resection was performed in 103 patients with 74 (71.3%) bilateral TGCT and 23 (22.8%) bilateral TGCT developing metachronously and synchronously, resp.; 6 (5.9%) TGCT developed in a solitary testicle. Histology of the enucleated TGCT revealed seminoma in 57 cases (56.4%), embryonal carcinoma in 20 cases (19.8%), mature teratoma in 15 cases (14.8 %), mixed/combined TGCT in 9 cases (8.9%). Mean tumor diameter was 15mm (5-30mm). Associated testicular intraepithelial neoplasia (TIN) was diagnosed in 84% of the cases, 82 (79%) patients underwent local radiation with 18 Gy, 21 patients underwent close follow-up.

Results: After a median follow-up of 89 (2-199) months 102 patients (99%) are NED, 1 patient died due to systemic tumor progression. In 80 patients with associated TIN treated by local radiation 2 local relapses developed, whereas 4 patients developed local recurrences after 3, 6, 12, and 165 months without radiation, all patients have been salvaged by inguinal orchiectomy. Testosterone levels are normal in 84 (83.1%) patients, 10 patients (9.7%) developed hypogonadism, 6 patients (6.3%) remained on their preoperatively low testosterone levels. 4/6 patients who postponed local radiation for paternity reasons, successfully fathered a child after organ sparing surgery.

Conclusions: After longterm follow-up of more than 7 years organ sparing surgery represents a viable therapeutic approach in patients with bilateral TGCT with an excellent postoperative outcome. Tumor enucleation might be considered as standard approach if the guidelines/recommendations are respected: organ confined tumor < 20mm, multiple biopsies of the tumor bed, normal LH and testosterone serum levels preoperatively, adjuvant local irradiation postoperatively in selected cases, close follow-up and high compliance.