Abstract
Simple SummaryTestis sparing surgery (TSS) is a safe treatment option in selected cases of testicular tumors in adults, focusing on technical feasibility, oncologic safety, preserving of testicular function, and long-term outcome. This surgical technique is also increasingly being considered in children, as benign tumors are more common in this population. With this systematic review, we aim to evaluate outcome of TSS and to investigate under which circumstances TSS can be considered safe in boys with testicular tumors. Based on the current practice described in this systematic review, combined with the outcome of TSS, we would like to suggest an algorithm to guide clinicians in determining the appropriate surgical treatment in prepubertal patients less than 12 years of age with a testicular tumor. TSS may lead to improved testicular function and quality of life in boys with testicular tumors. Objective: The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors. Methods: A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports. Results: Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%). Conclusion: TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.
Highlights
Testicular tumors in the pediatric population are rare
In this systematic review we present the current practice of surgical treatment of testicular tumors and aim to evaluate outcome of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered as a safe treatment option in pediatric patients with testicular tumors
The purpose of this review was to present the current practice of surgical treatment of testicular tumors, evaluate outcome of TSS, and identify under which conditions TSS could be considered a safe treatment option in pediatric patients with a testicular tumor
Summary
Germ cell tumors (GCT) are the main group of pediatric testicular tumors. Prepubertal children and adolescents with testicular tumors were considered together as a pediatric population. Type I testicular GCTs are non-germ cell neoplasia in situ (GCNIS)-associated, resembling benign teratomas and malignant yolk sac tumors (YST). Type II testicular GCTs often contain mixed histology and are malignant and GCNIS-associated [2,3,4]. Sex cord-stromal tumors (SCSTs) encompass a smaller group of testicular tumors and are mostly benign, malignant transformation is present in about 5% of the cases [5]. Malignant testicular tumors are more common in the (post)pubertal age group, compromising 12% of cancers in adolescents, compared to 4% in prepubertal children [1]. Age is described as most the important prognostic risk factor in patients with GCTs according to the largest retrospective evaluation of the MAKEI dataset [4]
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