Long-term outcome for patients with high volume retroperitoneal teratoma undergoing post-chemotherapy surgery

We determined outcomes in patients with testicular cancer with large volume (greater than 10 cm) retroperitoneal teratoma treated with post-chemotherapy retroperitoneal lymph node dissection.

A retrospective review of our testicular cancer database was performed from 1995 to 2005 to identify patients undergoing post-chemotherapy retroperitoneal lymph node dissection for residual masses larger than 10 cm with final pathological examination revealing teratoma. A total of 99 patients met the study inclusion criteria.

A total of 27 patients presented with disease limited to the retroperitoneum, 46 had 2 or 3 disease sites and 26 had 4 or more disease sites. Mean and median hospital stay was 7.3 and 5.0 days, respectively. There were 23 recurrences in 27 locations with the most common being pulmonary in 5, mediastinal in 5 and retroperitoneal in 5. The 2 and 5-year disease-free survival was 86% and 75% with a mean followup of 42 months. The 2-year disease-free survival for patients presenting with retroperitoneal disease only was 86% compared to 79% and 41% for patients presenting with 2 to 3 disease sites and more than 4 disease sites, respectively (p = 0.004). The 2-year disease-free survival was 78% for patients undergoing retroperitoneal lymph node dissection alone, 80% for retroperitoneal lymph node dissection plus 1 or 2 other sites and 40% for retroperitoneal lymph node dissection plus resection of 3 or more disease sites (p = 0.026).

The recurrence rate for resected post-chemotherapy high volume teratoma is 25% at 5 years. The most common sites of recurrence are the lung, mediastinum and retroperitoneum.