title: The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin.
abstract: OBJECTIVE
  To assess the outcome of patients with testicular nonseminomatous germ cell tumors (TNSGCT) undergoing intrathoracic residual tumor resection (RTR) after previous chemotherapy (CT) at a single institution.
  
  
  METHODS
  The office records of all patients who underwent intrathoracic RTR for TNSGCT after CT at a single institution from January 2000 through December 2006 were reviewed.
  
  
  RESULTS
  There were 124 consecutive patients (age 33.1 ± 8.4 years) with residual masses who underwent 189 surgical procedures. Morbidity and mortality rates were 12.7 and 0.5%, respectively. Complete resections could be achieved in 121 patients (97.6%). In the resected lung masses, necrosis was the predominant histology, (44.4 vs. 29% in mediastinal masses p = 0.018). Mature teratoma was the leading histology in the mediastinum (62.1 vs. 39.5% in lung masses, p = 0.0006). Fifty-nine out of 124 patients (47.6%) required interventions at both lungs and had discordant histological results in 20.3% (12/59) of the cases. Mean survival was 86.6 ± 2.6 months. The overall 5-year-survival and 10-year survival rates were 87 and 85%, respectively. Viable cancer, incomplete resections, age ≥ 34 years, and major pulmonary resections were associated with inferior survival in a univariate Cox proportional hazards model. In a multivariable Cox proportional hazards model, viable cancer, incomplete resections, and major pulmonary resections remained significant prognostic factors.
  
  
  CONCLUSIONS
  In selected TNSGCT patients with residual masses, RTR can be performed safely after CT. RTR should be attempted at all sites because of possible discordant histological differentiation. Complete and parenchyma-sparing resections are associated with excellent long-term survival, which can be influenced by the surgeon.
authors.affiliation: Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schirren
authors.forename: Stephan
authors.initials: S
authors.lastname: Trainer
authors.forename: Michael
authors.initials: M
authors.lastname: Eberlein
authors.forename: Anja
authors.initials: A
authors.lastname: Lorch
authors.forename: Jörg
authors.initials: J
authors.lastname: Beyer
authors.forename: Servet
authors.initials: S
authors.lastname: Bölükbas
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome