PULMONARY METASTASECTOMY AS SECONDARY-TREATMENT FOR TESTICULAR-TUMORS

Patients presenting with synchronous and metachronous metastases of no nseminomatous testicular tumors are candidates for pulmonary metastase ctomy after receiving definitive primary treatment, which includes sem icastration, eventually retroperitoneal lymphadenectomy, and definitel y chemotherapy. One hundred four such patients (age, 14 to 79 years; m edian age, 27 years) underwent pulmonary metastasectomy from 1972 to 1 990, representing 15.8% of the pulmonary metastasectomies performed du ring the same period. Of the 117 operations performed, eight were repe at operations. Median sternotomy, posterolateral and, later, transvers e thoracotomies were the standard surgical approaches used to remove t he single and multiple metastases randomly distributed in both lungs. Wedge resections and atypical segmentectomies (66%), lobectomies (15%) , anatomic segmentectomies (9%), pneumonectomies (3%), bilobectomies ( 3%), and mediastinal lymphadenectomies (65.4%) were the various proced ures performed. Of the 104 patients, metastasectomy was complete in 80 and incomplete in 24. The 30-day mortality was 2.0%. Life table analy sis revealed a survival rate of 77%, 70%, 66%, and 59% at 1, 2, 3, and 5 years, respectively. Of all prognostic factors examined, complete r esection of the metastases seems to be the most significant factor inf luencing the prognosis.