Objective
To evaluate the oncologic outcomes and histologic concordance of postchemotherapy
residual liver mass resection with postchemotherapy retroperitoneal lymph node dissection
(PC-RPLND).
Methods
Retrospective review of our prospectively maintained germ cell tumor (GCT) surgical
database identified patients with nonseminomatous GCT who underwent both postchemotherapy
residual liver mass resection and PC-RPLND between 1990 and 2015.
Results
A total of 36 patients were identified, of whom 29 (81%) presented with a liver mass
at initial diagnosis and 17 (47%) received second-line chemotherapy before liver resection.
Teratoma was found in 8 (22%) and 5 (14%) of PC-RPLND and liver resection specimens,
respectively. Viable GCT was found in 5 (14%) and 4 (11%) of PC-RPLND and liver resection
specimens, respectively. Histologic discordance was observed in 4 of 19 patients (21%;
95% confidence interval [CI] 6.1%-46%); in all cases, liver resection specimens contained
teratoma or viable GCT while PC-RPLND revealed only fibrosis or necrosis. At 3 years
after surgical intervention, the Kaplan-Meier estimated probability of cancer-specific
survival was 75% (95% CI 55%-85%) and the probability of progression-free survival
was 75% (95% CI 56%-87%).
Conclusion
In this contemporary cohort, clinically significant discordance was observed between
the histology of metastatic liver masses and that of retroperitoneal lymph nodes.
The benefit of postchemotherapy liver mass resection for patients with advanced nonseminomatous
GCT is supported by favorable survival outcomes. Until more reliable predictors of
postchemotherapy histology exist, complete surgical resection of all sites of residual
disease should be performed whenever feasible.
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Article info
Publication history
Published online: April 25, 2018
Accepted:
April 10,
2018
Received:
January 19,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
