RETROPERITONEAL SURGERY - ITS WIDER ROLE IN THE MANAGEMENT OF MALIGNANT TERATOMA

Objective To review the results of the use of laparotomy to excise ret roperitoneal metastases in patients with malignant teratoma of the tes tis. Patients and methods The results of surgery for retroperitoneal t eratoma metastases in 37 patients during the 5-year period from 1988 t o 1993 were reviewed. Information on sexual dysfunction was obtained u sing a postal questionnaire. Results Patients were divided into three groups: the first comprised 28 patients who underwent elective surgery (excision of residual disease) after platinum and bleomycin-based che motherapy. The second group comprised four patients who underwent inte rventional surgery to excise disease not responding to treatment, afte r which they completed chemotherapy. The third group comprised five pa tients 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 undergon e re-operation. Conclusions In addition to removing residual disease a fter primary chemotherapy, surgery has a wider role in the management of metastatic teratoma. Carefully timed interventional surgery for dis ease not responding to chemotherapy can be lifesaving. Surgery for ear ly relapse should be preceded by chemotherapy but surgery alone is app ropriate where relapse occurs several years after primary treatment, a lthough raised levels of tumour markers or extensive recurrence might be an indication for preliminary chemotherapy.