Role of postchemotherapy surgery in the management of patients with liver metastases from germ cell tumors.
OBJECTIVE
To evaluate the role of postchemotherapy adjunctive surgery in patients with liver metastases from germ cell cancer (GCT).


METHODS
Forty-three male patients with nonseminoma were treated in different multicenter treatment protocols between 1990 and 1999, and they underwent hepatic surgery. The results of postchemotherapy surgical resection, histologic findings found during postchemotherapy surgery, and prognostic factors for survival were assessed.


RESULTS
Thirty-five of 43 patients (81%) were initially diagnosed with liver metastases and advanced GCT, and 8 patients (19%) presented with metachronous liver metastases after a median interval of 16 months (range, 6-103 months). Twelve patients (28%) had isolated liver metastases after completion of chemotherapy, while 31 patients (72%) had additional residual extrahepatic tumor masses. Liver surgery included tumor excision or segmentectomy in 32 patients (74%) and hepatectomy (right/left) or resection of multiple segments in 11 patients (26%). Histologic analysis of postchemotherapy resected residua yielded necrosis in 67%, teratoma in 12%, and viable cancer in 21%. Additional resections at other sites have been performed in 31 patients revealing necrosis in 61% (n = 19), teratoma in 29% (n = 9), and vital carcinoma in 10% (n = 3). In 39% of patients, histologic findings differed among liver and other resection sites. Refractoriness to chemotherapy was associated with a shorter survival after surgery, and a trend was seen in patients with elevation of AFP.


CONCLUSIONS
The high rate of viable cancer and teratoma found in liver specimens, differing histologic results at residual tumor locations, and the high survival rate achieved support a multidisciplinary approach including resection of liver masses since no accurate selection of patients can narrow the use of surgery.
Hartmann
Jörg Thomas
JT
Department of Hematology/Oncology/Immunology, UKT Medical Center II, Eberhard-Karls-University, Tübingen, Germany. jorg.hartmann@med.uni-tuebingen.de
Rick
Oliver
O
Oechsle
Karin
K
Kuczyk
Markus
M
Gauler
Thomas
T
Schöffski
Patrick
P
Schleicher
Jan
J
Mayer
Frank
F
Teichmann
Reinhard
R
Kanz
Lothar
L
Bokemeyer
Carsten
C
D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology; D013724:Teratoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome