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
