Short- and long-term outcomes after large pulmonary resection for germ cell tumors after bleomycin-combination chemotherapy.
BACKGROUND
Treatment of nonseminomatous germ cell tumors frequently requires bleomycin-combination chemotherapy followed by resection of residual disease. Bleomycin administration however raises concerns with respect to postoperative respiratory complications, particularly for patients undergoing large pulmonary resections. We undertook an institutional review to determine the outcome of large pulmonary resections after bleomycin-combination chemotherapy.


METHODS
Between 1981 and 2001, 530 patients presented to our institution for resection of residual intrathoracic disease for either metastatic testicular or primary mediastinal nonseminomatous germ cell tumors. We subsequently reviewed 32 of these patients who required pneumonectomy (n = 19; RIGHT = 9, LEFT = 10) or bilobectomy (n = 13) after bleomycin-combination chemotherapy.


RESULTS
There were four operative deaths (13%). All postoperative deaths occurred in patients undergoing right-sided resections (pneumonectomy, n = 2; bilobectomy, n = 2) as a consequence of pulmonary complications. Operative survivors had a pulmonary morbidity of 18%. Fourteen of 20 long-term survivors were found to have a satisfactory performance status at follow-up.


CONCLUSIONS
Otherwise young and healthy male nonseminomatous germ cell tumors patients requiring large pulmonary resections after bleomycin-combination chemotherapy appear to be at higher than anticipated risk for pulmonary-related morbidity and mortality. However long-term survivors report an acceptable functional status.
Department of Surgery, Thoracic Division, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Rafael S
RS
Andrade
Kenneth A
KA
Kesler
Jamison L
JL
Wilson
Jo Ann
JA
Brooks
Brett D
BD
Reichwage
Karen M
KM
Rieger
Lawrence H
LH
Einhorn
John W
JW
Brown
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D015993:Life Tables; D008171:Lung Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013736:Testicular Neoplasms / Q000473:pathology; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin