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

Published:January 28, 2020DOI:https://doi.org/10.1016/j.urology.2019.12.032

      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.
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      References

        • Ghazarian AA
        • Kelly SP
        • Altekruse SF
        • Rosenberg PS
        • McGlynn KA
        Future of testicular germ cell tumor incidence in the United States: forecast through 2026.
        Cancer. 2017; 123: 2320-2328
        • Steele GS
        • Richie JP
        • Stewart AK
        • Menck HR
        The National Cancer Data Base report on patterns of care for testicular carcinoma, 1985-1996.
        Cancer. 1999; 86: 2171-2183
        • Roth BJ
        • Greist A
        • Kubilis PS
        • Williams SD
        • Einhorn LH
        Cisplatin-based combination chemotherapy for disseminated germ cell tumors: long-term follow-up.
        J Clin Oncol. 1988; 6: 1239-1247
        • Kollmannsberger C
        • Daneshmand S
        • So A
        • et al.
        Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery.
        J Clin Oncol. 2010; 28: 537-542
        • Ehrlich Y
        • Brames MJ
        • Beck SD
        • Foster RS
        • Einhorn LH
        Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumors: is a postchemotherapy retroperitoneal lymph node dissection needed after complete remission?.
        J Clin Oncol. 2010; 28: 531-536
        • Dowling CM
        • Assel M
        • Musser JE
        • et al.
        Clinical outcome of retroperitoneal lymph node dissection after chemotherapy in patients with pure embryonal carcinoma in the orchiectomy specimen.
        Urology. 2018; 114: 133-138
        • Ravi P
        • Gray KP
        • O'Donnell EK
        • Sweeney CJ
        A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor.
        Ann Oncol. 2014; 25: 331-338
        • Albers P
        • Weissbach L
        • Krege S
        • et al.
        Prediction of necrosis after chemotherapy of advanced germ cell tumors: results of a prospective multicenter trial of the German Testicular Cancer Study Group.
        J Urol. 2004; 171: 1835
        • Einhorn LH
        • Williams SD
        • Mandelbaum I
        • Donohue JP
        Surgical resection in disseminated testicular cancer following chemotherapeutic cytoreduction.
        Cancer. 1981; 48: 904-908
        • Fadel E
        • Court B
        • Chapelier AR
        • Droz JP
        • Dartevelle P
        One stage approach for retroperitoneal and mediastinal metastatic testicular tumor resection.
        Ann Thorac Surg. 2000; 69: 1717-1721
        • Rick O
        • Bokemeyer C
        • Weinknecht S
        • et al.
        Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer.
        J Clin Oncol. 2004; 22: 3713-3719
        • Tiffany P
        • Morse MJ
        • Bosl G
        • et al.
        Sequential excision of residual thoracic and retroperitoneal masses after chemotherapy for stage III germ cell tumors.
        Cancer. 1986; 57: 978-983
        • Gerl A
        • Clemm C
        • Schmeller N
        • et al.
        Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours.
        Br J Cancer. 1994; 70: 960-965
        • Stephenson AJ
        • Sheinfeld J
        The role of retroperitoneal lymph node dissection in the management of testicular cancer.
        Urol Oncol. 2004; 22 (discussion 234-5): 225-233
        • Carver BS
        • Sheinfeld J
        Management of post-chemotherapy extra-retroperitoneal residual masses.
        World J Urol. 2009; 27: 489-492
        • Hejase MJ
        • Donohue JP
        • Foster RS
        • Bihrle R
        • Coogan CL
        • Rowland RG
        • et al.
        Post-chemotherapy resection of nonseminomatous germ cell testicular tumors metastatic to the mediastinum.
        J Urol. 1996; 156: 1345-1348
        • Fizazi K
        • Tjulandin S
        • Salvioni R
        • et al.
        Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ celltumors: prognostic factors and role of postsurgery chemotherapy-results from an international study group.
        J Clin Oncol. 2001; 19: 2647-2657
        • Hartmann JT
        • Candelaria M
        • Kuczyk MA
        • Schmoll HJ
        • Bokemeyer C
        Comparison of histological results from the resection of residual masses at different sites afterchemotherapy for metastatic non-seminomatous germ cell tumours.
        Eur J Cancer. 1997; 33: 843-847
        • van Vledder MG
        • van der Hage JA
        • Kirkels WJ
        • Oosterhuis JW
        • Verhoef C
        • de Wilt JH
        Cervical lymph node dissection for metastatic testicular cancer.
        Ann Surg Oncol. 2010; 17: 1682-1687
        • Masterson TA
        • Shayegan B
        • Carver BS
        • et al.
        Clinical impact of residual extraretroperitoneal masses in patients with advancednonseminomatous germ cell testicular cancer.
        Urology. 2012; 79: 156-159
        • Heidenreich A
        • Pfister D
        • Witthuhn R
        • Thüer D
        • Albers P
        Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection.
        Eur Urol. 2009; 55: 217-224
        • Baniel J
        • Foster RS
        • Rowland RG
        • Bihrle R
        • Donohue JP
        Complications of post-chemotherapy retroperitoneal lymph node dissection.
        J Urol. 1995; 153: 976-980
        • Qvist HL
        • Fosså SD
        • Ous S
        • Høie J
        • Stenwig AE
        • Giercksky KE
        Post-chemotherapy tumor residuals in patients with advanced nonseminomatous testicularcancer. Is it necessary to resect all residual masses?.
        J Urol. 1991; 145 (discussion 302-3): 300-302
        • Brenner PC
        • Herr HW
        • Morse MJ
        • et al.
        Simultaneous retroperitoneal, thoracic, and cervical resection of postchemotherapy residual masses in patients with metastatic nonseminomatous germ cell tumors of the testis.
        J Clin Oncol. 1996; 14: 1765-1769
        • de Perrot M
        • Eaton D
        • Bedard PL
        • Jewett M
        Anterior transpericardial approach for post-chemotherapy residual mid visceral mediastinal mass in metastatic germ cell tumors.
        J Thorac Cardiovasc Surg. 2013; 145: 1136-1138
        • Heidenreich A
        • Haidl F
        • Paffenholz P
        • Pape C
        • Neumann U
        • Pfister D
        Surgical management of complex residual masses following systemic chemotherapy for metastatic testicular germ cell tumours.
        Ann Oncol. 2017; 28: 362-367
        • Pearce SM
        • Golan S
        • Gorin MA
        • et al.
        Safety and early oncologic effectiveness of primary robotic retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer.
        Eur Urol. 2017; 71: 476-482
        • Pooleri GK
        • Bijalwan P
        • Kesavan R
        • Philip A
        • Keechilat P
        Robot-assisted supine extraperitoneal retroperitoneal lymph node dissection: a novel approach for template dissection in post-chemotherapy residual mass in non-seminomatous germ cell tumours.
        J Robot Surg. 2019; 13: 171-173
        • Calaway AC
        • Einhorn LH
        • Masterson TA
        • Foster RS
        • Cary C
        Adverse surgical outcomes associated with robotic retroperitoneal lymph node dissection among patients with testicular cancer.
        Eur Urol. 2019; 76: 607-609
        • Wei S
        • Chen M
        • Chen N
        • Liu L
        Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis.
        World J Surg Oncol. 2017; 15: 98