Simultaneous Vs Sequential Retroperitoneal, Thoracic and Cervical Resection of Post Chemotherapy Residual Masses in Patients With Metastatic Nonseminomatous Germ Cell Tumors of the Testis.

Abstract

OBJECTIVE:

To compare a simultaneous vs sequential approach to residual post chemotherapy mass resections in metastatic testis cancer.

METHODS:

A retrospective review was performed of patients who underwent retroperitoneal and thoracic/cervical resection of post chemotherapy residual masses between 2002 and 2018. Group 1: "Simultaneous" (Combined Retroperitoneal and Thoracic/Cervical resections on the same date); Group 2: "Sequential" (Retroperitoneal and Thoracic/Cervical resections at separate dates).

RESULTS:

During the study period, 35 simultaneous and 17 sequential resections were performed. The median age at surgery was 28 years (Range 16-61). The median follow-up from last surgical procedure was 62.7 months (Range 0.4-194). Histology revealed teratoma in 38 (73.1%) patients, necrosis in 8 (15.4%) and viable tumor in 6 (11.5%). Discordant pathology findings between thoracic/cervical and abdominal resections were noted in 16 (30.8%) patients. No differences were observed between the simultaneous vs sequential groups in median operating time (585 minutes vs 545 minutes, P = .64), blood loss (1300 vs 1300 mls, P = .42), or length of stay (9 vs 11 days, P = .14). There was no difference between the 5-year (65.7% vs 68.6%) relapse-free survival between the 2 groups (P = .84) or the 5-year (88.6% vs 100%) overall and disease-specific survival (P = .25).

CONCLUSION:

Simultaneous resection of retroperitoneal and thoracic/cervical post chemotherapy metastases is a feasible in some patients. It requires multidisciplinary collaboration and a longer primary procedure.

• Authors: Gregory J Nason, Laura Donahoe, Marc de Perrot, Ishan Aditya, Michael A S Jewett, Philip L Bedard, Aaron R Hansen, Peter Chung, Padraig Warde, Lynn Anson-Cartwright, Joan Sweet, Martin O'Malley, Eshetu G Atenafu, Robert J Hamilton
• Journal: Urology (Urology) Vol. 138 Pg. 69-76 (04 2020) ISSN: 1527-9995 [Electronic] United States
• PMID: 32004556 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Chemotherapy, Adjuvant
• Feasibility Studies
• Humans
• Male
• Middle Aged
• Neck Dissection (adverse effects, methods, statistics & numerical data)
• Neoadjuvant Therapy
• Neoplasm, Residual
• Neoplasms, Germ Cell and Embryonal (secondary, therapy)
• Patient Care Team
• Postoperative Complications (epidemiology, etiology)
• Retroperitoneal Space (surgery)
• Retrospective Studies
• Testicular Neoplasms (pathology, secondary, therapy)
• Thoracic Surgical Procedures (adverse effects, methods, statistics & numerical data)
• Young Adult