43 Testis sparing surgery instead of radical orchiectomy might be safe and feasible in patients with unilateral small testicular mass with bilateral testis: Results of a multicenter study

43 Testis sparing surgery instead of radical orchiectomy might be safe and feasible in patients with unilateral small testicular mass with bilateral testis: Results of a multicenter study Keske M.1, Canda A.E.2, Yalcin S.3, Kilicarslan A.4, Kibar Y.3, Tuygun C.5, Onder E.6, Atmaca A.F.2, Yildirim A.7, Ozkanli S.S.8, Kandemir O.9, Kargi T.10, Sar M.11, Tugcu V.10, Resorlu B.12, Aslan Y.13, Sarikaya S.14, Boylu U.15, Cicek A.F.16, Basar H.17, Tuncel A.13, Balbay M.D.18 1 Ataturk Training And Research Hospital, Dept. of Urology, Ankara, Turkey, 2Ankara Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospita, Dept. of Urology, Ankara, Turkey,3Gulhane Military Medical Academy, Dept. of Urology, Ankara, Turkey, 4Ataturk Training and Research Hospital, Dept. of Pathology, Ankara, Turkey, 5Diskapi Yildirim Beyazit Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 6Diskapi Yildirim Beyazit Training and Research Hospital, Dept. of Pathology, Ankara, Turkey, 7Medeniyet University, Goztepe Training and Research Hospital, Dept. of Urology, Istanbul, Turkey, 8Medeniyet University, Goztepe Training and Research Hospital, Dept. of Pathology, Istanbul, Turkey, 9Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Dept. of Pathology, Ankara, Turkey, 10Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dept. of Urology, Istanbul, Turkey, 11Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dept. of Pathology, Istanbul, Turkey, 12Ankara Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 13Numune Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 14Kecioren Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 15Umraniye Training and Research Hospital, Dept. of Urology, Istanbul, Turkey, 16Gulhane Military Medical Academy, Dept. of Pathology, Ankara, Turkey, 17Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 18Memorial Sisli Hospital, Dept. of Urology, Istanbul, Turkey INTRODUCTION & OBJECTIVES: Although radical nephrectomy is the standard approach in the surgical treatment of kidney masses, currently nephron-sparing surgery (NSS) is frequently applied particularly in smaller renal masses. In an attempt to evaluate if the similar situation might be applied in testicular masses, we investigated if testis-sparing surgery (TSS) could be performed in small testicular masses in patients with bilateral testis. MATERIAL & METHODS: In this retrospective, multicenter study, data of patients who underwent radical inguinal orchiectomy (n=252) for testicular mass from 11 different institutions with a pathologic tumor size of 3 cm or less were included. Patients divided into 3 groups in terms of tumor size including Group-I (0-1 cm, n=35), Group-II (1.1-2 cm, n=99) and Group-III (2.1-3 cm, n=118). Of the patients, pathology reports were re-reviewed in 112 patients. RESULTS: Mean patient age was 32.3 years. No significant differences were detected in terms of pathologic reports after re-reviewing the pathologic slides in 112 patients. Benign lesions were reported in 54.3%, 33.3% and 14.4% of Groups I, II and III, respectively. Group I had significantly higher rate of benign lesions compared to Group II and III (p=0.047 and p=0.000, respectively). Group II had significantly higher rate of benign lesions compared to Group III (p=0.002). In the neighboring testis tissue, intra-tubular germ cell neoplasia (ITGCN) was detected in 20%, 42.4% and 41.5% of Groups I, II and III, respectively. Group I had significantly lower rate of ITGCN compared to Group II and III (p=0.031 and p=0.034, respectively). No significant difference was detected in terms of ITGCN between Group II and III (p=0.894). A tumor cut-off size of 1.5 cm was found to be significant for detecting benign tumor in the testis. In the neighboring testis tissue, ITGCN was detected in 30.1% (n=22) of the patients with a tumor size of ≤1.5 cm (n=73) and in 42.4% (n=76) of the patients with a tumor size of 1.6-3.0 cm (n=179) (p=0.069). Benign lesions were detected in 50.7% (n=37) of the patients with a tumor size of ≤1.5 cm and in 17.9% (n=32) of the patients with a tumor size of 1.6-3.0 cm (p=0.000). CONCLUSIONS: TSS might be performed with oncological safety particularly in patients with a testicular mass size of 1.5 cm or less in patients with bilateral testis following intraoperative frozen section evaluation of the excised mass and tumor bed biopsies. Similar to NSS in kidneys, TSS in small testicular masses is expected to have the advantages of preserving residual testicular function and fertility with additional benefits on patient psychology that warrants further research. Eur Urol Suppl 2015; 14(8): e1373