Surgical resection of residual tumor masses after chemotherapy in testicular cancer

• Published in: Hellenic journal of surgery Vol. 84; no. 2; pp. 84 - 91
• Main Authors: Korkolis, D. P., Aggeli, Ch, Passas, I., Gontikakis, E.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.04.2012
• Subjects: Medicine; Medicine & Public Health; Review Article; Surgery; Non-seminoma cancer; Seminoma cancer; Retroperitoneal lymphadenectomy; Testicular cancer
• ISSN: 0018-0092; 1868-8845
• DOI: 10.1007/s13126-012-0010-4

Surgical resection of residual retroperitoneal lymph nodal masses or residual visceral metastases after chemotherapy is an important part of the oncological approach in patients with advanced testicular cancer. The aim is the complete and radical surgical excision of the persistent disease that may contain mature teratoma in 30–40%, and active cancer cells in 10–20% of the patients. Mature teratoma should be removed because of its predisposition for local growth, malignant transformation and possible recurrence. Furthermore, persistent neoplastic masses with active cancer cells represent a form of disease with endogenous or exogenous chemo-resistance, predisposing to neoplastic relapse if not removed, despite any second-line chemotherapy. In patients with seminoma tumour, the retroperitoneal dissection is indicated for tumours > 3cm, as well as for those < 3cm which are positive on FDG-PET scanning performed 6-8 weeks after completion of chemotherapy. In patients with advanced non-seminoma tumours, retroperitoneal lymphadenectomy should be carried out in residual masses of any size, due to the high risk of developing mature teratoma or active cancer, shortly after chemotherapy. Depending on the localization of the residual lymph node mass in relation to the primary tumour, an ipsilateral or bilateral modified lymphadenectomy with nerve preservation should be carried out. When necessary, partial replacement of the inferior vena cava or the abdominal aorta, as well as concomitant resection of any diseased organs, is performed. The complete resection of residual masses is accompanied by a long disease-free survival rate >90%. Even after “salvage” chemotherapy, aggressive surgical treatment achieves cure in 55% of patients. In highly selected patients, surgical treatment of liver metastases is appropriate and is followed by a five-year survival rate >70%. In all cases, treating these recurrences requires an experienced surgical team and a multi-oncological approach.