Impact of unnecessary exploratory laparotomy on the treatment of patients with metastatic germ cell tumor Journal Article

  

Authors:	Stephenson, A. J.; Russo, P.; Kaplinsky, R.; Sheinfeld, J.
Article Title:	Impact of unnecessary exploratory laparotomy on the treatment of patients with metastatic germ cell tumor
Abstract:	Purpose: Patients with testicular germ cell tumors (GCTs) may undergo unnecessary diagnostic or surgical procedures when this diagnosis is not considered. In a cohort of patients who underwent exploratory laparotomy for unsuspected metastatic GCT we determined the impact of this surgery on morbidity, therapeutic delay and cancer therapy. Materials and Methods: Between 1980 and 2001, 40 patients who underwent exploratory laparotomy for unsuspected metastatic GCT were later referred to our department for management. Patient records were reviewed retrospectively. Results: Mean patient age at exploratory laparotomy was 34 years. All patients had a midline retroperitoneal mass and 14 had disease at other sites. At the time of evaluation at our institution abnormalities on physical examination and testicular sonogram were identified in 8 (20%) and 22 (55%) patients, respectively. Elevated serum α-fetoprotein and/or β-human chorionic gonadotropin were identified in 26 patients (65%). Eight patients (22%) experienced complications from exploratory surgery. The median interval from laparotomy to chemotherapy was 29 days and in 48% of patients the delay in therapy was 30 days or greater. Of patients with a delay of 30 days or greater 60% required intensive chemotherapy (multiple regimens, or high dose or salvage chemotherapy) compared to 26% with a delay of less than 30 days (p = 0.01). Conclusions: Exploratory laparotomy contributes to therapeutic delay in a substantial number of patients and it complicates cancer therapy. At presentation evidence to suggest GCT was present in all patients, which highlights the importance of physician awareness in making a prompt diagnosis.
Keywords:	adolescent; adult; cancer chemotherapy; cancer survival; clinical article; controlled study; treatment outcome; middle aged; cancer surgery; retrospective studies; antineoplastic agent; laparotomy; protein blood level; metastasis; cohort analysis; postoperative complication; early diagnosis; echography; neoplasm metastasis; testicular neoplasms; retroperitoneal tumor; physical examination; physician attitude; germ cell tumor; testis; chorionic gonadotropin beta subunit; alpha fetoprotein; unnecessary procedures; germinoma; humans; human; male; priority journal; article
Journal Title:	Journal of Urology
Volume:	171
Issue:	4
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2004-04-01
Start Page:	1474
End Page:	1477
Language:	English
DOI:	10.1097/01.ju.0000118788.97570.fa
PROVIDER:	scopus
PUBMED:	15017201
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-1642277893&partnerID=40&md5=ea8d315553a8ee4596804c88764058cd
Notes:	J. Urol. -- Cited By (since 1996):6 -- Export Date: 16 June 2014 -- CODEN: JOURA -- Source: Scopus

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