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Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

38949718
15687
10.1245/s10434-024-15687-x
ASO Author Reflections
ASO Author Reflections: Surgical Management of Paratesticular Rhabdomyosarcoma
Martynov Illya MD illya.martynov@uk-gm.de

12
Sparber-Sauer Monika PhD 34
Heinz Amadeus MD 36
Vokuhl M. Christian PhD 5
Ebinger Martin PhD 6
Gesche Jens MD 7
Münter Marc PhD 8
Koscielniak Ewa PhD 3
Fuchs Jörg PhD 9
Seitz Guido PhD 12
Cooperative Soft Tissue Sarcoma Study Group
1 grid.10253.35 0000 0004 1936 9756 Department of Pediatric Surgery and Urology, University Hospital Giessen-Marburg, Philipps-University, Marburg, Germany
2 grid.411067.5 0000 0000 8584 9230 Department of Pediatric Surgery, University Hospital Giessen-Marburg, Giessen, Germany
3 https://ror.org/01xet8208 grid.459687.1 0000 0004 0493 3975 Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart, Germany
4 University of Medicine Tübingen, Tübingen, Germany
5 https://ror.org/01xnwqx93 grid.15090.3d 0000 0000 8786 803X Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany
6 https://ror.org/03esvmb28 grid.488549.c Department of Pediatric Hematology and Oncology, University Children’s Hospital, Tuebingen, Germany
7 Pediatric Surgery, Josefinum, Augsburg, Germany
8 https://ror.org/059jfth35 grid.419842.2 0000 0001 0341 9964 Department of Radiooncology, Klinikum Stuttgart, Stuttgart, Germany
9 https://ror.org/03esvmb28 grid.488549.c Department of Pediatric Surgery and Urology, University Children’s Hospital, Tuebingen, Germany
29 6 2024
29 6 2024
2024
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12 6 2024
12 6 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Philipps-Universität Marburg (1009)Open Access funding enabled and organized by Projekt DEAL.

issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

Paratesticular rhabdomyosarcoma (PTRMS) is the most prevalent non-germ-cell scrotal malignant tumor, accounting for approximately 5% of all pediatric scrotal masses and 7% of all pediatric rhabdomyosarcomas (RMS).1,2 The recommended surgical approach for PTRMS involves primary inguinal orchidectomy with high ligation of the spermatic cord before tumor mobilization. However, protocol violations during primary surgery are common and often lead to incomplete tumor resections, necessitating revisional surgeries known as pretreatment re-excision (PRE). PRE can downstage tumors from IRS III (macroscopically incomplete tumor resection, R2) or IRS II (microscopically incomplete tumor resection, R1) to IRS I (microscopically complete tumor resection, R0), thus achieving excellent oncological outcomes. Nevertheless, there is a paucity of data on the effects of unsuccessful PRE, which may result in local R1/R2 situation, on event-free survival (EFS) or overall survival (OS).

Present

We evaluated the impact of the quality of initial and subsequent surgeries on the survival of patients with non-metastatic and metastatic PTRMS enrolled in the Cooperative Weichteilsarkom Studiengruppe (CWS) trials (CWS-96, 2002P) and the Soft Tissue Sarcoma Registry (SoTiSaR). Our findings reveal that the quality of local surgical control is frequently unsatisfactory, characterized by a high incidence of protocol violations during primary surgery (42%) and PRE (20%).3 Further, our analysis, using an unadjusted log-rank test, highlighted that R status following PRE is a significant prognostic factor for 5-years OS. This underscores the critical need for strict adherence to surgical guidelines, particularly during revisional surgery.

Future

Our study indicates that improvements are necessary in the quality of surgical local control for PTRMS. The path forward should focus on enhancing surgical training and preoperative planning to reduce protocol violations during both primary surgery and PRE. Notably, an R1 resection following PRE was associated with decreased OS, suggesting its potential role as a prognostic factor for patients with localized PTRMS.

Funding

Open Access funding enabled and organized by Projekt DEAL.

Disclosure

The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

This article refers to: Martynov I, Sparber-Saue M, Heinz A, et al. Importance of adequate surgical local control in fusion negative paratesticular rhabdomyosarcoma: data from the “Cooperative Weichteilsarkom Studiengruppe” trials CWS-96 2002P and European Soft Tissue Sarcoma Registry (SoTiSaR). Ann Surg Oncol. (2024). 10.1245/s10434-024-15568-3.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jörg Fuchs and Guido Seitz have contributed equally to the senior authorship of this paper.
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References

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Shapiro E, Strother D. Pediatric genitourinary rhabdomyosarcoma. J Urol. 1992;148(6):1761–8. 10.1016/s0022-5347(17)37023-4.1433603
2. Ahmed HU Arya M Muneer A Mushtaq I Sebire NJ Testicular and paratesticular tumours in the prepubertal population Lancet Oncol. 2010 11 5 476 483 10.1016/s1470-2045(10)70012-7 20434716
Ahmed HU, Arya M, Muneer A, Mushtaq I, Sebire NJ. Testicular and paratesticular tumours in the prepubertal population. Lancet Oncol. 2010;11(5):476–83. 10.1016/s1470-2045(10)70012-7.20434716
3. Martynov I Sparber-Saue M Heinz A Importance of adequate surgical local control in fusion negative paratesticular rhabdomyosarcoma: data from the “Cooperative Weichteilsarkom Studiengruppe” trials CWS-96 2002P and European Soft Tissue Sarcoma Registry (SoTiSaR) Ann Surg Oncol. 2024 10.1245/s10434-024-15568-3 38949718
Martynov I, Sparber-Saue M, Heinz A, et al. Importance of adequate surgical local control in fusion negative paratesticular rhabdomyosarcoma: data from the “Cooperative Weichteilsarkom Studiengruppe” trials CWS-96 2002P and European Soft Tissue Sarcoma Registry (SoTiSaR). Ann Surg Oncol. 2024. 10.1245/s10434-024-15568-3.38949718
