Resection of pulmonary metastases following chemotherapy for high stage testicular tumors.
BACKGROUND
Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients.


METHODS
Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated.


RESULTS
Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites.


CONCLUSIONS
All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.
Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey.
Saadettin Y
SY
Eskicorapci
Sinan
S
Ekici
M Necmettin
MN
Atsu
Riza
R
Dogan
Haluk
H
Ozen
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000627:therapeutic use; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin