[Postchemotherapy surgery in patients with non-seminomatous testicular tumors]

From 1982 to 1993, 220 patients with metastatic nonseminomatous germ cell testicular tumours were treated with a combination of cisplatin, vinblastine and bleomycin. Complete remission was achieved in 108 (49.1%) pts. on chemotherapy alone. Residual abdominal or pulmonary masses persisted on completion of chemotherapy in 85 (38.6%) pts. All of them had normal serum levels of tumour markers. In 13 (5.9%) pts tumour markers were positive. Fourteen (6.4%) pts died during primary chemotherapy. The pts with residual masses and normal tumour markers were treated by surgical exploration and masses removal. In 62 pts the masses were resected through laparotomy, in 19 pts through pulmonary surgery and in four pts laparotomy was followed later by pulmonary surgery. The masses removed at laparotomy consisted of necrotic and fibrotic tissue in 25.8%, mature teratoma in 61.3% and viable cancer was detected in 12.9% cases. In contrast, resected pulmonary masses consisted of necrotic and fibrotic tissue in 42.1%, mature teratoma in 26.3% and viable cancer in 31.6%. The total therapeutic outcome in 220 pts was as follows: 159 pts (72.3%) are alive and free of disease. Four pts (1.8%) live with the disease and 57 pts (25.9%) died from the disease. On the basis of their results the authors advocate: 1. Primary chemotherapy should be indicated for IIA and IIB stages of nonseminomatous testicular tumours. 2. Surgical exploration should be reserved for pts with residual abdominal and pulmonary masses bigger than 15 mm in diameter. 3. Operation should include a complete removal of all residual masses. 4. No reliable criteria indicating necrotic and fibrotic changes preoperatively were identified. (Tab. 4, Ref. 17.)