title: Is scrotal violation per se a risk factor for local relapse and metastases in stage I nonseminomatous testicular cancer?
abstract: OBJECTIVE
  To determine the risk of local recurrence and relapse in patients with Stage I nonseminomatous testicular cancer with scrotal violation.
  
  
  METHODS
  From 1983 to 1998, 75 patients with clinical Stage I nonseminomatous testicular cancer who were initially treated with orchiectomy and surveillance alone were retrospectively reviewed.
  
  
  RESULTS
  Of 75 patients with Stage I nonseminomatous testicular cancer, 13 had scrotal violation. The surgical margins and the spermatic cords were free of tumor in all patients. Five patients (38%) in the scrotal violation group and 17 patients (27%) in the inguinal orchiectomy group experienced relapses. The difference was not significant (P = 0.41). Local recurrence was not observed in either group. All relapses, except one in the standard inguinal orchiectomy group, were treated successfully with chemotherapy and postchemotherapy surgery, if needed. The progression rate and survival were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Scrotal violation without positive surgical margins and tumor spillage does not adversely affect relapse rate and survival. Therefore, scrotal violation per se is not an exclusion criterion for the surveillance-only policy in patients with Stage I nonseminomatous testicular germ cell cancer.
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: F T
authors.initials: FT
authors.lastname: Aki
authors.forename: C Y
authors.initials: CY
authors.lastname: Bilen
authors.forename: M I
authors.initials: MI
authors.lastname: Tekin
authors.forename: H
authors.initials: H
authors.lastname: Ozen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009919:Orchiectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012611:Scrotum / Q000601:surgery*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*