Background. The role of surgery in patients with pulmonary metastatic germ
cell tumors has been evolving since the 1970s. To evaluate the results of p
ulmonary resection, we reviewed our 28-year experience.
Methods. Between July 1967 and May 1995, 157 patients with testicular germ
cell tumors underwent pulmonary resections for suspected metastases. Their
clinical and pathological data were reviewed. Kaplan-Meier and Cox regressi
on models were used to analyze prognostic factors for survival after resect
ion of metastatic disease.
Results. All patients were male with median age of 27 years (range 15-65).
Complete resection was accomplished in 155 (99%) patients, viable carcinoma
was present in 44% (70) of the patients. Forty-one (26%) patients had meta
stases to other sites after pulmonary metastasectomy. The overall actuarial
survival 5 years after pulmonary resection was 68% for the entire group an
d 82% for patients diagnosed after 1985. On multivariate analysis, the adve
rse prognostic factors were metastases to nonpulmonary visceral sites (p =
0.0069) and the presence of viable carcinoma in the resected specimen (p <
0.0001).
Conclusions. With current chemotherapy regimens, almost 85% of the patients
with testicular germ cell tumors undergoing complete resection of their pu
lmonary metastases can be expected to achieve long-term survival. (C) 1998
by The Society of Thoracic Surgeons.