Spector CH, Salariato O, Brosio C, Colombatti A

Language: Spanish
References: 11
Page: 80-87
PDF size: 81.00 Kb.

ABSTRACT

Background: Cisplatin-based chemotherapy can be expected to induce complete regression of thoracic metastases in most of the patients with advanced germ cell testicular tumors. Notwithstanding, there are others in which residual masses after the systemic treatment are found. Surgery plays a meaningful role in the latter group of patients, because it may lead to the complete control of the disease. It also allows precise pathologic diagnoses, assessment of prognosis and eventually, prescription of further treatment, if needed. In cases of pulmonary nodules associated to present or former neoplastic diseases of various types, some authors concluded that videothoracoscopic resection should only be indicated for diagnostic purposes. Even though, we believe that the procedure is still very useful for the treatment of certain cases of lung and mediastinal presumptive metastases of germ cell testicular neoplasms. Population and methods: From 224 patients with advanced germ cell testicular carcinomas, 27 underwent 32 post-chemotherapy operations in order to resect thoracic masses. Most of them were open-lung local or wedge resections, but five have been videothoracoscopic procedures whose results are analyzed in this publication. Results: Three solitary pulmonary nodules were teratomas, two of them attached to the lung surface by a pedicle without pathologic tissue. One mediastinal mass had only fibrosis, and the remainder contained residual carcinoma. Except for the latter patient who died 8 months after the operation with widespread carcinomatosis, the other 4 are still disease-free without the need of further chemotherapy. There were neither morbidity nor mortality related to the procedures. Conclusions: In patients with advanced testicular germ cell carcinomas previously treated with cisplatin based chemotherapy, residual solitary pulmonary nodules and enlarged lymph nodes located in one side of the mediastinum, may be resected through videothoracoscopic approach, with the aim of removing the apparently single remaining sites of possible neoplastic disease. Our short experience allows us to state, that excision of mediastinal masses, although difficult and risky, is a feasible procedure. The type of resection, whether complete or not, and the tissue structure of the specimens, may lead either to further possible chemotherapy in certain cases of persistent carcinomas, or to observation in the case of teratomas and fibrosis.

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