Organ Preserving Surgery of Malignant Germ Cell Tumors

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Abstract
If a tumor arises in a solitary testis the patient loses fertility and requires lifelong androgen substitution. We describe the technique and results of organ preserving enucleation resection performed in 14 patients. The tumor was excised under (cold) ischemia via a mini-surgical technique using 2-fold magnification and blood vessels were localized intraoperatively by Doppler sonography. The procedure was successful in 10 of 14 patients. In 2 patients the organ required ablation later because of insufficient blood supply. Two patients had subnormal testosterone levels after treatment. There were no local recurrences. Prerequisites for this type of treatment are detailed knowledge of the vascular anatomy of the testis, tumor not too close to the rete testis, largest diameter 20 mm. or less, normal preoperative plasma testosterone level, postoperative local irradiation with 20 Gy., followup biopsies and hormonal status obtained 6 months after enucleation resection, and meticulous followup for early detection of local recurrences or systemic progression.