Orquiectomía parcial en tumor testicular: técnica quirúrgica y papel de la ecografía intraoperatoria

espanolOBJETIVO: Revision sistematica del tratamiento de pequenas masas testiculares (PMT) mediante cirugia conservadora testicular (CCT), incluyendo indicaciones, tecnicas quirurgicas y complicaciones, asi como la correlacion del examen de secciones congeladas (ESC) con la histologia final tumoral. Como objetivo secundario reportamos la experiencia inicial de nuestro centro en CCT. MATERIAL Y METODOS: Busqueda en Pubmed/Medline de estudios publicados hasta el 30 de junio de 2019 con las siguientes palabras clave: “testis sparing surgery”, “conservative surgery”, “partial orquiectomy” “testicular neoplasms”, “testis tumour”, “sex cord tumor”, “intraoperative ultrasonography”, “enucleation”, “excision” o” resection” sin limites de tiempo, en ingles y castellano, identificandose 20 articulos con un total de 204 CCT, siendo la serie con mayor tamano muestral de 28. En nuestro servicio se realizaron 8 CCT en 6 pacientes (dos tumores bilaterales) distribuidos entre 2016-2019. RESULTADOS: No se han informado de ensayos aleatorizados controlados que comparen CCT con orquiectomia radical. Las indicaciones para CCT son controvertidas, especialmente para pacientes con testiculos contralaterales normales. Se ha identificado el tamano tumoral como un predictor importante de enfermedad maligna y aunque no existe un punto de corte aprobado, las PMT ≤2 cm son las que mas se pueden beneficiar de CCT. La utilizacion de ecografia intraoperatoria (EI) es esencial para la localizacion de PMT, ya se este realizando una reseccion macroscopica o con microcirugia, ayudando a disminuir la tasa de complicaciones del procedimiento, descrita en CONCLUSIONES: La CCT para PMT permite mayor preservacion de parenquima sano, pero debe realizarse solo en casos seleccionados y en centros experimentados. La tecnica quirurgica es segura y viable, siendo claves la utilizacion de la EI y el ESC de la lesion para facilitar la decision quirurgica. EnglishOBJECTIVES: Systematic review of thetreatment of small testicular masses (STM) by testicular sparing surgery (TSS), including indications, surgical techniques and complications, as well as the correlation of the analysis of frozen sections (FSE) with the final tumor histology. As a secondary objective we report the initial experience of our center in TSS. MATERIAL AND METHODS: A systematic literature search of the Medline/PubMed database for studies published until June 30, 2019 with the following keywords: “testis sparing surgery”, “conservative surgery”, “partial orquiectomy” “testicular neoplasms”, “testis tumour”, “Sex cord tumor”, “intraoperative ultrasonography”, “enucleation”, “excision” or “resection” without time limits, in English and Spanish, identifying 20 articles with a total of 204 TSS, being the series with the largest sample size of 28. In our service, 8 TSS were performed in 6 patients (two bilateral tumor) distributed between 2016-2019. RESULTS: No randomized controlled trials comparing TSS with radical orchiectomy have been reported. The indications for TSS are controversial, especially for patients with normal contralateral testicles. Tumor size has been identified as an important predictor of malignant disease and although there is no approved cut-off point, STM ≤2 cm are the ones that can benefit most from TSS. The use of intraoperative ultrasound (IU) is essential for the location of STM, whether a macroscopic or microsurgical resection is being performed, helping to reduce the rate of complications of the procedure, described in CONCLUSIONS: TSS for STM allows greater preservation of healthy parenchyma, but should be performed only in selected cases and in experienced centers. The surgical technique is safe and viable, the use of the IU and the FSE of the lesion being essential to facilitate the surgical decision making.