The Role of Residual Tumor Resection in the Management of Nonseminomatous Germ Cell Cancer of Testicular Origin

Purpose To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT). Patients and Methods Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment. Results Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis. Conclusion Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.

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Complications of postchemotherapy residual tumor resection in patients with germ cell cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16077 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16077-e16077 ◽

Cited By ~ 3

Author(s):

P. Albers ◽

C. Bingöl ◽

R. Witthuhn ◽

P. de Geeter

Keyword(s):

Germ Cell ◽

Tumor Size ◽

Cell Cancer ◽

Tumor Resection ◽

Residual Tumor ◽

Nerve Sparing ◽

Tumor Diameter ◽

Residual Tumor Resection ◽

Residual Tumor Size ◽

Extent Of Surgery

e16077 Background: Residual tumor resection (RTR) is mandatory in all patients with advanced germ cell tumors and visible residual disease after chemotherapy. Full bilateral RTR is the proposed standard of care. However, in lately published series, the rate of nerve-sparing procedures was only 40%. Stage-related RTR may decrease surgical complications, enhance the rate of postoperative antegrade ejaculations and may not compromise oncological efficacy. Methods: A retrospective analysis of 98 patients in a tertial referral center with RTR (2003–2008) was performed using the RTR database and patients´ charts to correlate the extent of surgery to complications and outcome. Results: 49% of patients initially had IGCCCG intermediate and poor prognosis features. In 34%, residual tumor diameter was >5 cm. With a median age of 33 yrs (17–65), the median time of surgery was 210 min (90–604) with a median blood loss of 500 cc (50–5000). In 25 of 98 patients a full bilateral RTR was necessary to remove all residual tumors. The median residual tumor diameter in patients with full bilateral RTR without nerve-sparing was 10.9 cm (1.5–30) as opposed to 4.3 cm (0.5–20) in patients with modified template and/or nerve-sparing approaches (not significant). In 10 pts a nephrectomy and in 9 pts a resection of the vena cava was necessary. Only 2 of each had a bilateral RTR. All CTCAE grade III/VI complications like intraoperative hemorrhage (n=25, 11/25 bilateral RTR), postoperative lymphocele (n=8, 6/8 bilateral RTR), and retrograde ejaculation (15% with modified template and/or nerve-sparing, 100% with bilateral RTR) were significantly correlated with the residual tumor size and with the field of resection. Four patients relapsed, one had an in-field relapse after a template resection. One patient died due to a postoperative aorto-duodenal fistula. Conclusions: The complication rate of RTR is strongly related to the median residual tumor size and the extent of surgery. A full bilateral resection in all patients may result in unnecessary complications in a considerable cohort of patients. The field of resection should be adapted to the primary localization of disease and full bilateral resections should be performed only in patients with bilateral disease. No significant financial relationships to disclose.

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