Is high cord radical orchidectomy always necessary for testicular cancer?

Background: Radical high cord inguinal orchidectomy remains the standard for diagnosis, staging and treatment of testicular neoplasms. Low cord orchidectomy is an alternative to the high cord orchidectomy. Objective: To test the hypothesis that there is no difference in relapse rate or mortality between high and low cord orchidectomy for the treatment of testicular cancer. Methods: A retrospective study was undertaken of all orchidectomies performed for testicular cancer at our hospital between 1981 and 2002. Results: Overall, 120 high cord orchidectomies and 102 low cord orchidectomies were performed for testicular cancer between 1981 and 2002 at our hospital. Analysis showed that there was no significant difference in the mean age of the patients, the rate of relapse, mean time to relapse or survival between surgical approach for stage I tumours. For stage 2-4 tumours, there were not sufficient numbers to comment on the statistical significance of relapse or survival differences. Conclusions: The trend suggests that there is no statistically significant difference in the rate of relapse and mortality between high and low cord orchidectomy for clinically stage 1 tumours. We would, therefore, advocate either a high or low cord orchidectomy for clinically stage 1 tumours.