EN-BLOC AORTIC RESECTION FOR BULKY METASTATIC GERM-CELL TUMORS

Between 1989 and 1993, 97 patients with stages B3 and/or C nonseminoma tous germ cell tumors of the testes underwent induction chemotherapy f ollowed by retroperitoneal lymph node dissection, Of these patients 6 (ages 22 to 41 years) had gross extension of tumor into the aortic adv entitia at operation, which necessitated en bloc aortic and, on 3 occa sions, iliac artery resection for complete tumor removal. Aortic conti nuity was restored by a woven Dacron tube or bifurcated graft. All gra fts were covered with omentum. There were no postoperative vascular co mplications. Pathological study of the residual retroperitoneal diseas e demonstrated that 2 patients had mature teratoma only, 2 had mature teratoma with occasional nests of immature teratoma and 2 had residual yolk sac, embryonal or choriocarcinoma elements. The latter 2 patient s underwent postoperative salvage chemotherapy with varying combinatio ns of bleomycin, etoposide, ifosfamide and cisplatin. At 4 to 55 month s 4 patients were disease-free, while 2 died of metastatic disease. No problems related to the aortic reconstruction have occurred. This sma ll experience demonstrates that, if necessary, complete surgical en bl oc extirpation of bulky metastatic germ cell tumors and the aorta/ilia c artery can be performed safely with a satisfactory long-term outcome .