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Thorac Cardiovasc Surg 2012; 60(06): 405-412
DOI: 10.1055/s-0031-1299584
Original Thoracic
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Authors

  • Joachim Schirren

    1   Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany

  • Stephan Trainer

    1   Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany

  • Michael Eberlein

    2   Division of Pulmonary, Critical Care, and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States

  • Anja Lorch

    3   Departments of Hematology and Oncology, Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany

  • Jörg Beyer

    4   Departments of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany

  • Servet Bölükbas

    1   Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany
Further Information

Publication History

26 August 2011

07 November 2011

Publication Date:
01 March 2012 (online)

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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.

Keywords

germ cell tumor - pulmonary metastasectomy - residual mass - chemotherapy - metastases