Treatment of Leydig cell tumors of the testis: Can testis-sparing surgery replace radical orchidectomy? Results of a systematic review

Abstract

IntroductionThe gold standard for Leydig cell tumors (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. Acquisition of evidenceStudies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. Synthesis of evidenceThe present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months. In the TSS group, the follow-up varied from 6 to 192 months.Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%.None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrence.In selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. ConclusionsThe results confirm the favorable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis.