title: The role of thoracotomy in managing postchemotherapy residual thoracic masses in patients with nonseminomatous germ cell tumours.
abstract: OBJECTIVE
  To evaluate the clinical outcome and identify prognostic variables in patients with nonseminomatous germ cell tumours undergoing postchemotherapy thoracotomy for residual masses, as the role of this procedure is controversial.
  
  
  METHODS
  Of 385 patients who underwent postchemotherapy retroperitoneal lymph node dissections between 1988 and 1998, 105 also had 130 thoracotomies. The clinical presentation, chemotherapy regimens, marker status, primary tumour histology, pathology of all resected masses, and clinical outcome of these 105 patients were analysed.
  
  
  RESULTS
  The overall discordance rate for synchronous thoracic and retroperitoneal masses was 28%; that for asynchronous thoracic and retroperitoneal masses was 57%. Independent prognostic factors for residual thoracic teratoma or cancer were teratoma (mature or immature) in the primary tumour or retroperitoneal teratoma or cancer. Although three of 12 patients with residual thoracic cancer remained with no evidence of disease, residual thoracic cancer is an independent prognostic factor (P < 0.001) against disease-free survival.
  
  
  CONCLUSIONS
  Postchemotherapy thoracotomy yields important prognostic information, and is therapeutic for most patients with teratoma and a subset with residual viable cancer. The prognostic criteria predictive of fibrosis are not sufficiently accurate to omit resection of residual thoracic masses.
authors.affiliation: Division of Urology, Department of Surgery, Evanston Northwestern Healthcare, Evanston, IL, USA. msmcguire@attbi.com
authors.forename: M S
authors.initials: MS
authors.lastname: McGuire
authors.forename: F
authors.initials: F
authors.lastname: Rabbani
authors.forename: H
authors.initials: H
authors.lastname: Mohseni
authors.forename: M
authors.initials: M
authors.lastname: Bains
authors.forename: R
authors.initials: R
authors.lastname: Motzer
authors.forename: J
authors.initials: J
authors.lastname: Sheinfeld
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D018237:Germinoma / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D013736:Testicular Neoplasms / Q000188:drug therapy*; D013899:Thoracic Neoplasms / Q000556:secondary / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*