Testis-sparing surgery versus radical orchiectomy in patients with Leydig cell tumors.

Objectives: To compare retrospectively the outcome of testis-sparing surgery (TSS) to radical orchiectomy (RO) in patients with Leydig cell tumor (LCT).

Methods: Between 1992 and 2008, 16 patients with LCT of the testis were identified. All but 1 tumor could be detected by ultrasonography. Alpha-fetoprotein and beta-human chorionic gonadotropin levels were normal in all patients. Eight patients underwent RO (mean age at surgery 42 years [27-61]; median tumor size 12.9 mm [10-25]) and the remaining 8 underwent TSS (mean age at surgery 34 years [18-49]; median tumor size 8.6 mm [4-23]). Staging (abdominal computed tomography and chest x-ray or thoracic computed tomography) was negative in all patients.

Results: Median follow-up was 77 months (17-186) after RO and 42 months (1-86 months) after TSS. There was no local recurrence or metastasis in patients after RO. A metachronous LCT was removed from the spermatic cord 29 months after TSS of the ipsilateral testis in 1 patient. Another patient underwent surgical exploration of the testis 31 months after ipsilateral TSS because of a suspicious lesion identified in ultrasonography; a tumor was ruled out by histopathology.

Conclusions: In the medium term, TSS is a safe procedure in patients with LCT <25 mm.