Operative management and outcomes of testicular tumors in children: a 10-year multicentric Egyptian experience

Abstract Background This national study highlights the surgical management and outcomes of pediatric testicular tumors to evaluate our treatment approaches. All male patients younger than 18 years diagnosed with primary testicular tumors and treated at six Egyptian surgical units from 2014 to 2024 were included. Data were analyzed regarding clinical characteristics, operative details, adjuvant therapy, pathological variants, and overall outcomes. Results The study included 36 patients with a median age of 3.5 years (range: 12 days-17 years). Twenty-six patients (72%) were prepubertal, while 10 (28%) were postpubertal. Benign lesions were observed in 21 patients (58%), while 15 patients (42%) had malignant tumors. Four patients had metastatic disease at diagnosis, and all of them were postpubertal. Twenty-seven patients underwent radical high inguinal orchiectomy, whereas testicular-sparing surgery (TSS) was performed in 9 patients (25%). All patients who underwent TSS were prepubertal and had negative serum tumor markers. According to Children's Oncology Group staging system, 32 patients (89%) were classified as stage I, three patients as stage III, and one patient as stage IV. The four patients with stage III and IV disease received adjuvant chemotherapy, and two of them underwent retroperitoneal lymph node dissection to resect residual para-aortic/iliac nodes. One patient with stage III seminoma developed distant relapse after 20 months of remission, which was controlled with intensive chemotherapy. At a median follow-up of 58 months, all patients were still alive. The 5-year overall and event-free survival rates for all patients were 100% and 96%, respectively. Conclusions Radical orchiectomy is still performed for many patients due to insufficient remaining testicular parenchyma. TSS is highly recommended whenever feasible for prepubertal patients with benign-appearing tumors and sufficient healthy testicular tissue. The prognosis for pediatric testicular tumors is generally excellent across various age groups and pathological types. However, malignant tumors with metastases may be associated with less favorable outcomes.