Contemporary Role of Testis Sparing Surgery: a Systematic Review

Testis-sparing surgery (TSS) represents a therapeutic choice for testicular cancer (TC). However, international guidelines are very cautious about the use of the testis-sparing technique, namely due to the lack of certain indications and long-term oncological outcomes. The aim of this systematic-review is to illustrate current trends of what may today be the uses of organ-sparing surgery in TC, to evaluate the relationship between the organ-sparing safety and oncological features such as definitive histology, tumour size, and post-surgery oncological outcomes. This analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. An electronic search of the Medline and Embase was undertaken until September 2014. The search was limited to English-Language articles. Current indications of TSS are synchronous bilateral testicular tumours, metachronous contralateral tumours, or tumour in a solitary testis with normal preoperative testosterone levels. Moreover, histological characteristics should not be taken into account when performing a TSS approach. TSS outcomes for germ cell tumours are encouraging and we reported high rates of disease-free survival and a few cases of patients receiving neoadjuvant chemotherapy or radiotherapy. In light of the examined, TSS could be considered a viable alternative to radical surgery of the testis but it should be performed in specialised centres with competence.