Retroperitoneal surgery: its wider role in the management of malignant teratoma

To review the results of the use of laparotomy to excise retroperitoneal metastases in patients with malignant teratoma of the testis.

The results of surgery for retroperitoneal teratoma metastases in 37 patients during the 5-year period from 1988 to 1993 were reviewed. Information on sexual dysfunction was obtained using a postal questionnaire.

Patients were divided into three groups: the first comprised 28 patients who underwent elective surgery (excision of residual disease) after platinum and bleomycin-based chemotherapy. The second group comprised four patients who underwent interventional surgery to excise disease not responding to treatment, after which they completed chemotherapy. The third group comprised five patients who underwent surgery for relapsed disease; two had suffered an early and three a late relapse. Overall, 34 patients are alive, four are considered to have residual disease and two have recently undergone re-operation.

In addition to removing residual disease after primary chemotherapy, surgery has a wider role in the management of metastatic teratoma. Carefully timed interventional surgery for disease not responding to chemotherapy can be lifesaving. Surgery for early relapse should be preceded by chemotherapy but surgery alone is appropriate where relapse occurs several years after primary treatment, although raised levels of tumour markers or extensive recurrence might be an indication for preliminary chemotherapy.