Significance of spermatic cord invasion in radical inguinal orchidectomy: Will a modified subinguinal orchidectomy suffice?

Introduction And Objectives: Radical inguinal orchidectomy with ligation and division of the spermatic cord at the deep inguinal ring is the treatment of choice for testicular mass suspicious of cancer. In the era of organ preserving and minimally invasive surgery, it may be possible to propose a less radical sub-inguinal orchidectomy that may avoid the morbidity associated with opening the inguinal canal. The effect of this approach on oncological margins is not known. The aim of this article was to investigate the presence of spermatic cord involvement after a radical inguinal orchidectomy with a view to test feasibility of a modified sub-inguinal approach for testicular tumour excision.

Materials And Methods: A retrospective study on all orchidectomies performed for suspected testicular cancer was performed at a single hospital from over an 8-year period from January 2005 to December 2013. Non-cancerous lesions were excluded after histopathological review. All testicular malignancies were included and detailed histopathological review was performed.

Results: A total of 121 orchidectomies were performed over the 8-year period. Three patients had spermatic cord involvement. Spermatic cord involvement did not adversely affect the outcome in these patients after a median follow-up of 5 years irrespective of tumour histology. The proximal spermatic cord was not involved in any testicular germ cell tumours on further cord sectioning, the only patient with proximal cord involvement had a B-cell lymphoma.

Conclusion: We postulate that a sub-inguinal modified orchidectomy may be a less invasive alternative to radical inguinal orchidectomy, with comparable oncological outcomes based on low risk of spermatic cord involvement, which in itself is not a prognostic factor. We require further long-term follow-up studies on patients who have undergone this approach to validate the oncological outcomes and report the possible advantage of lower post-operative complications with this technique.