title: Role of postchemotherapy surgery in the management of patients with liver metastases from germ cell tumors.
abstract: 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.
authors.affiliation: Department of Hematology/Oncology/Immunology, UKT Medical Center II, Eberhard-Karls-University, Tübingen, Germany. jorg.hartmann@med.uni-tuebingen.de
authors.forename: Jörg Thomas
authors.initials: JT
authors.lastname: Hartmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Rick
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.forename: Markus
authors.initials: M
authors.lastname: Kuczyk
authors.forename: Thomas
authors.initials: T
authors.lastname: Gauler
authors.forename: Patrick
authors.initials: P
authors.lastname: Schöffski
authors.forename: Jan
authors.initials: J
authors.lastname: Schleicher
authors.forename: Frank
authors.initials: F
authors.lastname: Mayer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Teichmann
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: 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