Subinguinal Orchidectomy for Testicular Cancer: Innovation or Unnecessary Advancement

TL;DR

This review compares subinguinal orchidectomy with traditional high inguinal orchidectomy for testicular cancer, finding similar oncological outcomes but limited evidence.

Contribution

The study evaluates the oncological outcomes and complications of subinguinal orchidectomy for testicular cancer using a systematic review of limited data.

Findings

Subinguinal orchidectomy showed no significant differences in oncological outcomes compared to high inguinal orchidectomy.

Unsatisfactory oncological control was observed in 12.5% of subinguinal cases, primarily due to cancer relapse.

Postoperative seromas occurred in 9.5% of subinguinal orchidectomy patients.

Abstract

Subinguinal orchidectomy is a variation of the traditional high inguinal approach for testicular cancer, differing in the level of spermatic cord excision. While the subinguinal approach preserves the inguinal canal and ilioinguinal nerve, concerns remain about the residual disease in the proximal cord and its impact on oncological outcomes. This review evaluates oncological outcomes and complications of subinguinal orchidectomy. A search was conducted across five databases (PubMed, Scopus, Google Scholar, Cochrane Library, and Embase). Studies reporting inguinal versus subinguinal orchidectomies, tumor grade, oncological outcomes, complications, and follow-up were included. Descriptive statistics were performed using Microsoft Excel (Microsoft Corporation, Redmond, WA). Of the 25 studies screened, two were eligible for review, including data from 264 patients (2000-2024). Subinguinal orchidectomy was done in 54.7% (n=144) of cases. Unsatisfactory oncological control was observed in 12.5% (n=18) of subinguinal cases, with 78% (n=14) due to cancer relapse, 16.5% (n=3) due to spermatic cord invasion (SCI), and 5.5% (n=1) due to positive margins. One study comparing subinguinal and high inguinal approaches found no differences in oncological outcomes for stage 1 and stage 2-4 cancers (p=0.91 and p=0.78, respectively). One study reported that 9.5% of patients who underwent subinguinal orchidectomy (n=4) developed seromas postoperatively. Current evidence, though limited, suggests no significant differences in oncological outcomes between subinguinal and high-inguinal orchidectomies. While retrospective studies support this, prospective trials are required to better evaluate the oncological risk-benefit ratio of subinguinal orchidectomy.

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