Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre

Our plain-English summary of Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre, by C.D. Fankhauser, A. Issa, E.W.C. Lee, et al (Annals of Surgical Oncology, 2021).

The study

• Authors: C.D. Fankhauser, A. Issa, E.W.C. Lee, C. Oing, P. Oliveira, A. Parnham, J. Oates, V. Sangar, A. Gulamhusein, N. Clarke
• Journal: Annals of Surgical Oncology
• Published: 2021;28(13):9217-9222
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Purpose: Hemiscrotectomy with en bloc orchidectomy represents a radical primary, completion, or salvage option in men with inguinoscrotal cancers. We describe our surgical technique and peri-operative and oncological outcomes.

Patients And Methods: Retrospective cohort study of 16 men treated at a supra-regional referral centre with open radical hemiscrotectomy with or without en bloc orchidectomy between 2010 and 2020. Peri-operative and survival outcomes were analysed.

Results: Radical hemiscrotectomy with or without en bloc orchidectomy was performed on 16 patients comprising 7 well-differentiated liposarcomas, 4 dedifferentiated liposarcomas, 2 leiomyosarcomas, 1 mesothelioma, 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma. Primary hemiscrotectomy was performed in four, completion hemiscrotectomy in nine and salvage hemiscrotectomy in three. The median hospital stay was 2 days [interquartile range (IQR) 2-4]. Four patients (25%) had post-operative complications including wound infection or haematoma. During a median follow-up of 18 months (IQR 2-66), one patient (6%) died following a recurrence in the pelvis and retroperitoneum.

Discussion: and 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 showed no recurrence.

© 2021. The Author(s).

In plain English

This retrospective single-centre study described a surgical operation, radical hemiscrotectomy (removal of one side of the scrotum) with or without en bloc orchidectomy (removal of the testis in one piece with it), and reported results in 16 men treated at a UK referral centre between 2010 and 2020. Most tumours were sarcomas. One patient had mesothelioma of the tunica vaginalis testis (the lining around the testis). The article did not discuss asbestos or any other exposure. Four men had primary surgery, nine had completion surgery after earlier scrotal surgery, and three had salvage surgery for recurrence. The median hospital stay was 2 days. Four patients (25%) had complications within 90 days: two wound infections and two haematomas. During a median follow-up of 18 months, one patient (6%), who had dedifferentiated liposarcoma, had a recurrence and died. The authors concluded that, with careful dissection, the operation is radical but safe. They noted selection bias and too little statistical power to comment on cancer outcomes.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-centre cohort study (surgical case series) with a description of surgical technique
• Who was studied: 16 men (mean age 56 years, range 20 to 80) who had open radical hemiscrotectomy with or without en bloc orchidectomy at The Christie NHS Foundation Trust, Manchester, UK, between 2010 and 2020. Tumours were 7 well-differentiated liposarcomas, 4 dedifferentiated liposarcomas, 2 leiomyosarcomas, 1 mesothelioma, 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma.
• Exposure: Not reported. The study examined a surgical procedure, and no asbestos or other exposure is discussed.
• Main results:
  • Four men had primary resection, nine had completion surgery and three had salvage surgery.
  • In the nine completion-surgery specimens, six of nine (67%) showed no tumour. Three had residual disease, one of which was mesothelioma.
  • The one mesothelioma was in the completion-surgery group and had residual disease in the hemiscrotectomy specimen. It was a mesothelioma of the tunica vaginalis testis, epithelial subtype.
  • Median hospital stay for all 16 patients was 2 days (IQR 2 to 4 days).
  • Four of 16 patients (25%) had 90-day post-operative complications: two (12%) wound infections treated with oral antibiotics and two (12%) haematomas managed conservatively.
  • During a median follow-up of 18 months (IQR 2 to 66), one patient (6%) with locally advanced dedifferentiated liposarcoma had recurrence in the pelvic and retroperitoneal lymph nodes and died 4 months after initial diagnosis.
• The authors' conclusion: The authors concluded that, if careful dissection is performed, radical hemiscrotectomy and en bloc orchidectomy is a radical but safe procedure with a short hospital stay. They added that haematoma and infection are the main complications and that, within limited follow-up, most men showed no recurrence.
• Limitations the authors state:
  • The study was retrospective and done at a single centre.
  • There was selection bias: small inguinoscrotal cancers are often treated elsewhere, and rare, large, sarcomatous or recurrent tumours were referred to this centre.
  • The study had insufficient statistical power to comment on cancer-related outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Hemiscrotectomy, Cohort Study, Well-Differentiated, Mesothelioma, Retroperitoneum.

Related studies

• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Malignant mesothelioma of the tunica vaginalis: a case with an unusually indolent course following radical orchidectomy and radiotherapy — J.L. Harmse, A.T. Evans, et al. (1999)
• What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK — A.C. Bibby, K. Williams, et al. (2016)
• Treatment Patterns and Outcomes of Patients With Advanced Pleural Mesothelioma at an Academic Referral Centre — S. Schmid, L. Zhan, et al. (2022)
• Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions — O. Lauk, M.A. Hoda, et al. (2014)
• Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data — J.B. Grogg, J.N. Fronzaroli, et al. (2021)

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