SEQUENTIAL RESECTION OF RESIDUAL ABDOMINAL AND THORACIC MASSES AFTER CHEMOTHERAPY FOR METASTATIC NONSEMINOMATOUS GERM-CELL TUMORS

Thirty-eight patients with advanced non-seminomatous germ cell tumours (NSGCTs) underwent multiple surgical interventions (two in 33 patient s, three in four patients, four in one patient) after cisplatin-based chemotherapy. All patients had normal serum tumour markers but persist ent radiographic masses. The larger mass was routinely resected first. Fifteen patients (39%) had dissimilar histological findings at sequen tial surgical procedures, 12 of whom demonstrated less favourable path ological features during the first operation and three at the second. Patients who underwent both retroperitoneal lymph node dissection (RPL ND) and lung resection showed less favourable histological features in the retroperitoneum in nine cases and in the lung in three cases. Eig ht of 16 patients (50%) without mature teratoma in their primary tumou rs showed complete necrosis/fibrosis at all surgical interventions, wh ereas all patients whose primary tumour was classified as malignant te ratoma intermediate demonstrated mature teratoma at least at one anato mical site. As histology of post-chemotherapy residual masses cannot b e extrapolated from one anatomical site to another, patients usually a re properly managed by excision of all residual masses. In particular, in patients with necrosis/fibrosis at lung resection omission of RPLN D is not advised.