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Surgical Management of Cervical Non-seminomatous Germ Cell Tumor Metastases
Obi I Nwosu1, Alexander J Jones1, Mohamedkazim Alwani1
1Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
Objective/Hypothesis:
Testicular cancer is the most common malignancy of young males. Limited reports describe perioperative and long-term outcomes after surgical resection of metastatic, cervical, non-seminomatous germ cell tumors (NSGCT). The objective of this study was to investigate the effectiveness and safety of cervical lymphadenectomy in the management of metastatic NSGCT.
Study Design:
Retrospective case series.
Methods:
A single institution, retrospective review from 1998 to 2020 of patients with metastatic NSGCT who underwent cervical lymphadenectomy was conducted. Clinicopathological, surgical, and postoperative data were collected and analyzed.
Results:
Sixty-eight predominantly white (91.0%) male patients with mean age 33.0 ± 11.3 years were included. Most (82.2%) presented with stage III disease at initial diagnosis. All patients had undergone primary platinum-based chemotherapy 1.0 to 22.7 months prior to selective ND. Surgery mainly involved nodal levels III (67.6%), IV (92.6%) and/or Vb (77.9%) and was frequently performed with concomitant thoracoabdominal NSGCT resections (63.2%). Cervical specimens predominantly revealed mature teratoma (83.8%) as solitary (69.1%) or component of mixed (14.7%) NSGCT. Ten (14.7%) perioperative complications occurred as vocal cord paresis (n = 6) from thoracic surgery and chyle leakage (n = 4). All resolved conservatively except two vocal cord paralyzes that required surgical repair due to tumor involvement of vagus nerve. Six instances of cervical recurrence occurred at median 12.5 (range, 5.8-38.6) months from ND, all re-demonstrating purely mature teratoma. The two-year cervical, non-cervical, and overall recurrence-free survivals were 83%, 55%, and 55%, respectively. Two-year disease-free and overall survivals were both 93%.
Conclusions:
Selective neck dissection is a safe, effective method for managing cervical NSGCT metastases.
Level Of Evidence:
4 Laryngoscope, 131:1528-1534, 2021.
Insights
Selective neck dissection effectively manages cervical non-seminomatous germ cell tumor (NSGCT) metastases in young males. This procedure shows favorable outcomes and safety for advanced testicular cancer patients.
Area of Science:
- Oncology
- Surgical Oncology
- Urologic Oncology
Background:
- Testicular cancer is the most common malignancy in young males.
- Limited data exists on surgical outcomes for metastatic non-seminomatous germ cell tumors (NSGCT).
Purpose of the Study:
- To evaluate the effectiveness and safety of cervical lymphadenectomy for metastatic NSGCT.
Main Methods:
- Retrospective review of 68 patients with metastatic NSGCT who underwent cervical lymphadenectomy between 1998 and 2020.
- Data analysis included clinicopathological, surgical, and postoperative outcomes.
Main Results:
- Most patients had stage III disease and received prior chemotherapy.
- Cervical specimens primarily showed mature teratoma.
- Perioperative complications included vocal cord paresis and chyle leakage, with most resolving conservatively.
Conclusions:
- Selective neck dissection is a safe and effective treatment for cervical NSGCT metastases.
- The procedure demonstrated good recurrence-free and overall survival rates.
