PERSISTENT CANCER IN POSTCHEMOTHERAPY RETROPERITONEAL LYMPH-NODE DISSECTION - OUTCOME ANALYSIS

Surgery following chemotherapy for treatment of metastatic testis canc er is reserved for partial remissions with localized tumors considered resectable. After primary chemotherapy, about 90% will have teratoma or necrosis and only 10% will have cancer. The concept of two cycles o f post operative chemotherapy in this small group with cancer is suppo rted by a 70% long term cure rate. A more difficult group of patients are those who have had not only primary but also salvage chemotherapy for refractory tumor. About 55% of these patients undergoing post (sal vage) chemotherapy RPLND surgery have persistent cancer in the resecte d specimen. There is no data to support the routine use of repeat salv age chemotherapy post operatively. Of 91 patients presenting for surge ry post salvage chemotherapy, 53 were considered completely resected a nd 36 incompletely resected. Of the 53 realistic candidates for cure w ith complete resections, 25 were given post operative repeat salvage c hemotherapy and 28 received none. 9 (36%) receiving more chemotherapy remained NED and 12 (43%) receiving none remained NED. 12 in each grou p died of disease. Therefore, there is no data to support routine repe at salvage chemotherapy in patients considered completely resected who had already received salvage chemotherapy pre-operatively. Rather the outcome in this cohort depends more on the completeness of its resect ability.