title: Extended cervico-thoracic metastasectomy for testicular non-seminomatous germ cell tumour masses through an inverse T and combined collar incision.
abstract: Non-seminomatous germ cell tumours (NSGCT) are the most common malignancy from testicular origin in young males. They are characterized by early formation of metastases along retroperitoneal and subsequent mediastinal lymph node stations. Following cisplatin-based induction chemotherapy, residual tumour masses should be removed surgically, although this implies the need for extended procedures. Such an approach can result in cure rates of over 70%. Herein, we report 2 cases of maximally extended surgery for metastatic malignant germ cell tumour of the testis. In both patients, diagnostic work-up revealed a NSGCT with retroperitoneal, mediastinal and cervical lymph node metastases. Multimodal protocols including induction chemotherapy and surgical removal of all primary and secondary tumour masses with curative intent were applied. An 'inverse T' incision in combination with a collar incision was chosen to approach the excessive supra-diaphragmatic tumour spread. This large-scaled surgical access offered an excellent exposure and allowed complete resection of all cervical and thoracic metastases in both patients. Abdominal tumour masses were resected through a standard median laparotomy. These 2 cases illustrate that complete tumour resection is feasible even in stages of NSGCT with generalized lymphatic spread. Metastasectomy should be offered to NSGCT patients despite the necessity of extended surgical approaches.
authors.affiliation: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schweiger
authors.affiliation: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Konrad
authors.initials: K
authors.lastname: Hoetzenecker
authors.affiliation: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria walter.klepetko@meduniwien.ac.at.
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy / Q000379:methods*; D009333:Neck; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D013909:Thorax; D055815:Young Adult
keywords: Germ cell tumour; Inverse T incision; Metastasectomy