title: Simultaneous retroperitoneal, thoracic, and cervical resection of postchemotherapy residual masses in patients with metastatic nonseminomatous germ cell tumors of the testis.
abstract: OBJECTIVE
  We report our experience with simultaneous resection of residual masses above and below the diaphragm in patients with metastatic nomseminomatous germ cell tumor (NSGCT) of the testis.
  
  
  METHODS
  Twenty-four patients underwent simultaneous resection of residual postchemotherapy masses in the retroperitoneum and chest, including three who also had radical neck dissection. All had been heavily pretreated with chemotherapy and five had undergone previous retroperitoneal lymph node dissections (RPLNDs).
  
  
  RESULTS
  The combined procedure was performed with no mortality and low morbidity. The median length of the procedure was 5 hours 45 minutes, median blood loss 500 mL, and median length of hospital stay 9 days. Complications included one patient with chylous ascites and one with a prolonged air leak, both of which resolved with conservative management. Eighteen patients had similar pathologic findings in all sites: 13 with necrosis only and five with teratoma only. Six patients had discordant pathology in the abdomen and chest, including one with viable tumor in the chest only and two with viable tumor in the abdomen only. The overall actuarial 5-year survival rate for all patients was 79%.
  
  
  CONCLUSIONS
  Simultaneous resection of neck, chest, and abdominal residual masses after chemotherapy for germ cell tumors is both a feasible and safe alternative to staged excision in selected patients who require surgical intervention at multiple sites and fulfills the objective of rendering patients disease-free in a single operative procedure.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Brenner
authors.forename: H W
authors.initials: HW
authors.lastname: Herr
authors.forename: M J
authors.initials: MJ
authors.lastname: Morse
authors.forename: J
authors.initials: J
authors.lastname: Sheinfeld
authors.forename: A
authors.initials: A
authors.lastname: Aprikian
authors.forename: G J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: R J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: D F
authors.initials: DF
authors.lastname: Bajorin
authors.forename: S
authors.initials: S
authors.lastname: Schantz
authors.forename: W R
authors.initials: WR
authors.lastname: Fair
authors.forename: M
authors.initials: M
authors.lastname: Burt
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009919:Orchiectomy; D011183:Postoperative Complications; D012186:Retroperitoneal Neoplasms / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000601:surgery