Pulmonary metastasectomy for testicular germ cell tumors: a 28-year experience.
BACKGROUND
The role of surgery in patients with pulmonary metastatic germ cell tumors has been evolving since the 1970s. To evaluate the results of pulmonary resection, we reviewed our 28-year experience.


METHODS
Between July 1967 and May 1995, 157 patients with testicular germ cell tumors underwent pulmonary resections for suspected metastases. Their clinical and pathological data were reviewed. Kaplan-Meier and Cox regression models were used to analyze prognostic factors for survival after resection of metastatic disease.


RESULTS
All patients were male with median age of 27 years (range 15-65). Complete resection was accomplished in 155 (99%) patients. Viable carcinoma was present in 44% (70) of the patients. Forty-one (26%) patients had metastases to other sites after pulmonary metastasectomy. The overall actuarial survival 5 years after pulmonary resection was 68% for the entire group and 82% for patients diagnosed after 1985. On multivariate analysis, the adverse prognostic factors were metastases to nonpulmonary visceral sites (p = 0.0069) and the presence of viable carcinoma in the resected specimen (p < 0.0001).


CONCLUSIONS
With current chemotherapy regimens, almost 85% of the patients with testicular germ cell tumors undergoing complete resection of their pulmonary metastases can be expected to achieve long-term survival.
Liu
D
D
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Abolhoda
A
A
Burt
M E
ME
Martini
N
N
Bains
M S
MS
Downey
R J
RJ
Rusch
V W
VW
Bosl
G J
GJ
Ginsberg
R J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018237:Germinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D011379:Prognosis; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology*