Is it necessary to place a surgical clamp early in the spermatic cord during testicular examination via inguinal approach?

Abstract

Objective

The presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination.

Materials and methods

Inguinal testis studies were performed over a two-year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients.

Results

Testicular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range: 21–82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study.

Conclusion

In our causistics, it seems that the surgical act consisting of the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients who will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.

Resumen

Objetivo

Se evalúa la presencia de células tumorales en el cordón espermático en pacientes sometidos a exploración testicular inguinal, con intención de avalar si la colocación de una pinza en el mismo resulta necesaria para evitar la diseminación tumoral.

Material y métodos

Durante dos años se realizó exploración testicular inguinal a 38 pacientes con diagnóstico de masa testicular. En todos los pacientes se evaluó la presencia de células tumorales en los vasos sanguíneos o linfáticos del cordón.

Resultados

Existió neoplasia testicular en 28 pacientes (20 seminoma, 5 tumor mixto y tres carcinoma embrionario) con una edad promedio de 42 años (rango 21-82). Fueron T1N0M0 21 casos, T1N1M0 tres, T2N0M0 dos y T2N1M0 dos, respectivamente. Independientemente del estadio y estirpe tumoral, en ninguno de los casos el examen de anatomía patológica evidencio células tumorales en los vasos del cordón.

Conclusión

En nuestra casuística parece que el gesto quirúrgico consistente en colocar una pinza precozmente en el cordón carece de fundamento científico. Sin embargo, este estudio tampoco permite afirmar que no realizar esta maniobra durante el procedimiento quirúrgico sea oncológicamente seguro. Se establece así un precedente para realizar estudios con mayor número de pacientes que permitan corroborar esta observación, lo que redundará en técnicas quirúrgicas menos traumáticas y seguras que permitan preservar el testículo y su funcionalidad.