POSTCHEMOTHERAPEUTIC SURGERY FOR METASTATIC TESTICULAR GERM-CELL TUMORS - RESULTS OF EXTENDED PRIMARY CHEMOTHERAPY AND LIMITED SURGERY

Objective. Postchemotherapy surgery has become an increasingly importa nt treatment for residual masses in germ cell tumors of the testis. Ho wever, it is still a challenge to find the optimal combination of chem otherapy and surgery for better survival and cure rates with lowest mo rbidity. This study evaluated the effectiveness of extended chemothera py followed by surgery resecting only the residual masses. Methods. Af ter an extended course (one or two additional courses after there is n o decrease in tumor size and/or after the normalization of tumor marke rs) of combination chemotherapies with cisplatin-based regimens, 32 pa tients underwent surgery for metastatic germ cell tumors of the testis . Complete excision of radiologically determined residual masses and m acroscopically suspicious neighboring nodes was performed rather than a conventional retroperitoneal lymph node dissection. Results. Histopa thologic examination of the resected specimens revealed teratoma in 17 (55%), fibrosis and/or necrosis in 9 (26.5%), and active residual tum or in 8 (23.5%) of the patients. The patients with residual tumor have been treated with additional chemotherapy. In the follow-up (mean, 28 .5 months) 4 patients have relapsed, and 1 died. None of the patients with residual teratomas have shown relapse. Only 1 of the 32 patients has had retrograde ejaculation. Conclusions. A more conservative appro ach, such as excision of the residual masses after an extended course of chemotherapy, has given excellent results both in the outcome of th e patients in the follow-up and in the rate of retrograde ejaculation. We therefore suggest that this approach would be a good alternative t o nerve-sparing surgery following chemotherapy.