Hepatic resection of metastatic testicular carcinoma: a further update

The goal of this study was to update the multidisciplinary review of patients who underwent resection of hepatic metastases of nonseminomatous germ cell testicular carcinoma at the Indiana University Medical Center.

The study involved retrospective chart review for 57 patients who underwent hepatic resection for treatment of metastatic nonseminomatous testicular carcinoma between June 1974 and May 1996. Patients were categorized according to the worst postchemotherapy pathologic diagnosis.

Chemotherapy has been highly effective in curing testicular carcinoma. However, even with platinum-based chemotherapy, one-third of patients either do not achieve complete cures or experience relapses. Since 1965, only 57 of the 2219 patients who underwent postchemotherapy retroperitoneal lymph node dissections for treatment of testicular carcinoma at our center underwent hepatic resection for treatment of metastatic disease. Because teratomas have the propensity to degenerate into sarcomas and can cause symptoms resulting from compression, these lesions must be resected to achieve cures. In addition, the only chance for survival for patients with active disease but normal serum marker levels is with complete resection of the tumor burden.

We conclude that hepatic resection for treatment of metastatic testicular carcinoma is safe and efficacious for all patients except those with elevated marker levels after preoperative chemotherapy.