Resection of postchemotherapy residual masses and limited retroperitoneal lymphadenectomy in patients with metastatic testicular nonseminomatous germ cell tumors Journal Article
| Authors: | Aprikian, A. G.; Herr, H. W.; Bajorin, D. F.; Bosl, G. J. |
| Article Title: | Resection of postchemotherapy residual masses and limited retroperitoneal lymphadenectomy in patients with metastatic testicular nonseminomatous germ cell tumors |
| Abstract: | Background. Adjunctive retroperitoneal lymphadenectomy (RPLND) plays an important role in the management of patients with metastatic nonseminomatous germ cell tumors (NSGCT). Currently, a bilateral RPLND is recommended for residual disease after chemotherapy. Methods. The authors systematically have removed all residual masses and used intraoperative frozen section analysis to dictate the extent of surgery in the patients with NSGCT. If frozen section revealed necrosis, then a limited RPLND was performed; otherwise, a bilateral RPLND was attempted. Results. Forty patients with metastatic NSGCT were studied. Of the 40 patients, 21 had necrosis identified in frozen section analysis of the residual mass(es), with 18 (85.7%) confirmed in permanent section. Two patients had microscopic viable germ cell tumor, and one had microscopic teratoma in the residual mass with the remaining RPLND specimen tumor‐free. Overall, 18 of 45 patients (45%) had necrosis, 17 (42.5%) had teratoma, and 5(12.5%) had viable germ cell tumor, identified in permanent section analysis. The median follow‐up period was 36 months (range, 24‐60 months). Of the 40 patients, 8 (20%) experienced recurrences, although none were in the retroperitoneum; 5 were chest recurrences (4 germ cell, 1 teratoma), 2 were retrocrural recurrences (teratomas), and 1 recurrence was with liver metastasis. Of the tumors of the 21 patients with frozen section analysis showing necrosis who underwent resection of residual mass(es) and limited RPLND, 3 (14.3%) experienced recurrences; 2 had germ cell tumors in the chest, and 1 had liver metastasis. The remaining 18 (85.7%) patients had no evidence of disease, with a mean follow‐up of 33 months (range, 24‐60 months). Conclusions. These results suggest that in patients with metastatic NSGCT of the testis, postchemotherapy resection of all retroperitoneal masses followed by limited RPLND if frozen section analysis shows only necrosis is a safe alternative to a difficult, potentially morbid bilateral dissection. Copyright © 1994 American Cancer Society |
| Keywords: | adolescent; adult; cancer chemotherapy; clinical article; human tissue; treatment outcome; cancer surgery; clinical trial; histopathology; cisplatin; combined modality therapy; cancer staging; follow-up studies; paraaortic lymph node; lymph nodes; neoplasm staging; intraoperative care; lymph node excision; lymphadenectomy; carboplatin; metastasis; neoplasm recurrence, local; antineoplastic combined chemotherapy protocols; necrosis; tumor recurrence; testis tumor; testicular neoplasms; teratoma; retroperitoneal neoplasms; postchemotherapy; metastases; frozen sections; non seminomatous germinoma; ejaculation; retroperitoneal space; middle age; tumor necrosis; testis teratoma; germinoma; retroperitoneal lymphadenectomy; human; male; priority journal; article |
| Journal Title: | Cancer |
| Volume: | 74 |
| Issue: | 4 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 1994-08-15 |
| Start Page: | 1329 |
| End Page: | 1334 |
| Language: | English |
| DOI: | 10.1002/1097-0142(19940815)74:4<1329::Aid-cncr2820740424>3.0.Co;2-l |
| PROVIDER: | scopus |
| PUBMED: | 8055456 |
| DOI/URL: | |
| Notes: | Export Date: 14 January 2019 -- Article -- Source: Scopus |
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