Radical hemiscrotectomy and en-bloc orchidectomy: Surgical technique, perioperative and oncologic outcomes of a supra-regional UK referral centre
Fankhauser, Christian D Issa, Allaudin Lee, Esther Oing, Christoph Oliveira, Pedro Parnham, Arie S Oates, Jeremy E Sangar, Vijay K Gulamhusein, Aziz Clarke, Noel W
Fankhauser, Christian D
Issa, Allaudin
Lee, Esther
Oing, Christoph
Oliveira, Pedro
Parnham, Arie S
Oates, Jeremy E
Sangar, Vijay K
Gulamhusein, Aziz
Clarke, Noel W
Citations
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Abstract
Introduction & Objectives: Several rare urogenital cancers arising from tissues of the spermatic cord, epididymis, testis or scrotal skin have a
high risk of local recurrence. A radical resection by a hemiscrotectomy with or without en-bloc orchidectomy is therefore recommended to try to
reduce this complication. Given the limited literature describing this surgery, we summarized our surgical technique, perioperative and oncological
outcomes.
Materials & Methods: Retrospective cohort study of 16 men treated at a supra-regional referral centre between 2010 and 2020.
Results: Radical hemiscrotectomy and en-bloc orchidectomy was performed in 16 patients with a mean age of 56 years (range 20 to 80). Four men
had a primary resection, 9 underwent completion surgery with the remaining 3 undergoing salvage surgery. In men with primary surgery 2 patients
had well differentiated liposarcoma (WDLS), 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma. Completion surgery was performed
within a mean of 3 months (range 1-4 months) after initial diagnosis of dedifferentiated liposarcoma (DLS) in 4, WDLS in 2, leiomyosarcoma in 2
and mesothelioma in 1 patient. In the subsequent hemiscrotectomy specimens, 6 out of 9 (67%) showed no evidence of tumour whereas 3 patients
had residual disease including LDS, WDLS and mesothelioma (Figure 3). Salvage surgery was performed in two patients 31 and 50 months
after inguinal excision of a lipomatous mass which was incorrectly diagnosed as lipoma and reclassified on review as WDLS. The third patient
with salvage surgery was operated 72 months after orchiectomy as the patient initially refused completion orchiectomy and failed to re-attend
thereafter. The median hospital stay was 2 days (IQR 2–4). Four patients (25%) had 90-day postoperative complications. Two (12%) had wound
infections requiring oral antibiotics (Clavien-Dindo II), with the remaining 2 (12%) developing a haematoma (Clavien-Dindo I) which was managed
conservatively. During a median follow-up of 18 months (IQR 2-66), one patient (6%) initially presenting with locally advanced dedifferentiated
liposarcoma measuring 130x50x48mm had recurrence. Metastatic disease in the pelvic and retroperitoneal lymph nodes was diagnosed 2 months
after hemiscrotectomy with rapid clinical deterioration. He died 4 months after initial diagnosis despite palliative chemotherapy with Doxorubicin and
Olaratumab.
Conclusions: If careful dissection is performed, radical hemiscrotectomy and en-bloc orchidectomy is a radical but safe procedure with a short
hospital stay. Haematoma and infection represent the main complications and within limited follow-up most men appear to be cured
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Fankhauser CD, Issa A, Lee EWC, Oing C, Oliveira P, Parnham A, et al. Radical hemiscrotectomy and en-bloc orchidectomy: Surgical technique, perioperative and oncologic outcomes of a supra-regional UK referral centre. European Urology. 2021;79:S1764-S.