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Published on: November 29, 2018
Metastatic surgery in testis cancer
David Pfister1, Friederike Haidl, Pia Paffenholz
1Department of Urology, University Hospital Cologne, Cologne, Germany.
Purpose Of Review:
In testis cancer, prognosis is excellent even in metastatic disease. Treatment and timing of patients with multiple metastatic deposits can be challenging. This review was performed to underline the current guideline recommendations.
Recent Findings:
Depending on the primary histology, the indication of further surgical resections differ. In seminoma, resídual tumor resections are performed according to the results of a flouoro-deoxy-D-glucose-PET. Positive results must be considered critically, and to recent results it is advisable to first repeat flouoro-deoxy-D-glucose-PET to avoid overtreatment. In nonseminomatous germ cell cancer, complete remissions in good prognosis patients are followed and can be spared from surgery. All other patients still need to undergo postchemotherapy retroperitoneal lymph node dissection. In bone metastases, significant histology is found in 80% so that one should go for complete resection. In liver metastases, resections can be performed according to the histology in the retroperitoneum. Both resections, including vessel replacement, are usually performed in one session underlining the complex multidisciplinary approach. Pulmonal metastases, at least in one lobe, need to be resected. Brain metastases are rare with no standard treatment recommendation.
Summary:
Every patient should be presented in a multidisciplinary tumor board. Surgical interventions should be done in tertiary referral centers to achieve the best oncologic outcome and reduced morbidity.
Insights
Testis cancer treatment, even with metastases, has an excellent prognosis. This review highlights current guideline recommendations for managing patients with multiple metastatic deposits, emphasizing multidisciplinary care and specialized centers.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Guidelines
Background:
- Testis cancer generally has an excellent prognosis, even in cases of metastatic disease.
- Managing patients with multiple metastatic deposits presents treatment and timing challenges.
Purpose of the Study:
- To review and underline current guideline recommendations for testis cancer treatment.
- To provide clarity on managing complex metastatic cases.
Main Methods:
- Review of current guideline recommendations for testis cancer management.
- Analysis of treatment strategies based on primary histology and metastatic site.
Main Results:
- Surgical resection indications vary by primary histology (seminoma vs. nonseminoma).
- Fluorodeoxyglucose-PET (FDG-PET) guides residual tumor resection in seminoma; repeat PET advised for critical results.
- Post-chemotherapy retroperitoneal lymph node dissection is indicated for nonseminoma patients not in complete remission.
- Resection of bone, liver, and pulmonary metastases is recommended based on histology and location.
- Brain metastases are rare with no standard treatment.
Conclusions:
- Multidisciplinary tumor board presentation is crucial for all patients.
- Surgical interventions should be performed in tertiary referral centers for optimal outcomes and reduced morbidity.
