Testicular cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]

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## Overview

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Surgery is the mainstay of treatment for testicular cancer. Radical inguinal orchiectomy is recommended for every patient with testicular cancer for cure and histology.

## Surgery

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Radical inguinal orchiectomy

* Radical inguinal orchiectomy is the first treatment for any stage of testicular cancer and it is usually done as part of diagnosis.[1]

* A testicular prosthesis, or artificial testicle, can be placed in the scrotum after an orchiectomy. The prosthesis may be placed at the same time as surgery to remove the testicle, or it can be placed during another surgery done later.

Retroperitoneal lymph node dissection

* Retroperitoneal lymph node dissection (RPLND) may be done for stage I and II non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy, testicular cancer with features of malignancy, and nodal metastasis of sex cord stromal of testis.[2][3][4]
* Retroperitoneal lymph node dissection is the standard surgical approach for Nonseminoma germ cell tumors in primary as well as post-chemotherapy areas.[5][6]

* While you are under general anesthesia, the surgeon makes a large cut in the middle of the abdomen. The surgeon removes lymph nodes from the back of the abdomen. If the surgeon removes lymph nodes from the same side of the body as the tumor, it is called ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called bilateral RPLND.

* RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.

Salvage surgery

* Sometimes testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. The cancer that remains after these primary treatments is called residual disease. Surgery used to remove residual disease is called salvage surgery.

## References

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1. ↑ Nicolai N, Necchi A, Raggi D, Biasoni D, Catanzaro M, Piva L, Stagni S, Maffezzini M, Torelli T, Faré E, Giannatempo P, Pizzocaro G, Colecchia M, Salvioni R (February 2015). "Clinical outcome in testicular sex cord stromal tumors: testis sparing vs. radical orchiectomy and management of advanced disease". Urology. 85 (2): 402–6. doi:10.1016/j.urology.2014.10.021. PMID 25623702.
2. ↑ Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP (August 2003). "Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors?". Cancer. 98 (4): 753–7. doi:10.1002/cncr.11573. PMID 12910519.
3. ↑ Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J (August 2014). "Clinical outcomes of local and metastatic testicular sex cord-stromal tumors". J. Urol. 192 (2): 415–9. doi:10.1016/j.juro.2014.01.104. PMID 24518791.
4. ↑ Foster RS, Donohue JP (June 2000). "Retroperitoneal lymph node dissection for the management of clinical stage I nonseminoma". J. Urol. 163 (6): 1788–92. PMID 10799183.
5. ↑ Stephenson AJ, Sheinfeld J (2004). "The role of retroperitoneal lymph node dissection in the management of testicular cancer". Urol. Oncol. 22 (3): 225–33, discussion 234–5. doi:10.1016/j.urolonc.2004.04.029. PMID 15271322.
6. ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."

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