Hepatic Resection for Disseminated Germ Cell Carcinoma

Abstract

Improvements in operative technique and perioperative management have expanded the application of hepatic resection for metastatic cancer. Although a policy of aggressive surgical resection of residual pulmonary and retroperitoneal disease following chemotherapy and normalization of serum tumor markers has been adopted for disseminated germ cell carcinoma, resection of residual hepatic disease in these cases has not been addressed. This report concerns a series of prospectively randomized patients who received systemic cisplatin-based chemotherapy for testis cancer during the past 13 years. Twenty-eight patients underwent resection of residual hepatic disease after serologic remission. Most (23 of 28 patients) of these procedures were performed concomitantly with other cytoreductive procedures. There were no operative deaths, although 28% of the patients developed complications. The 2-year survival rate was 54%, with an average follow-up of 34 months. Patients were stratified into three groups based on the most aggressive histology noted in the resected specimen. Survival is predicted by this histologic classification system. Hepatic resection can be performed safely and is an important component in the treatment of disseminated testicular carcinoma.

Multidisciplinary Treatment of Advanced Testicular Tumor with Bulky Liver Metastasis

“…However, the strategy of further treatments may vary for patients with bulky visceral metastases. High-dose chemotherapy with peripheral blood stem cell transplantation is a vital option, although the 5-year survival rates of such cases remain below 50% [4,7]. Few recent treatment analyses of longterm results in patients with advanced liver metastases were reported.…”

“…Few recent treatment analyses of longterm results in patients with advanced liver metastases were reported. The only 2-year survival rate was surveyed to be 54% in 23 patients with disseminated liver metastases, who were treated with systemic chemotherapy and cytoreductive surgery [4].…”

“…However, 10-20% of advanced nonseminomatous germ cell tumors (NSGCT) are classified as the poor-risk group [1][2][3]. The survival is especially poor in patients with bulky nonpulmonary visceral metastases and/or extremely elevated serum tumor markers [4][5][6].…”

Hepatic Resection of Metastatic Testicular Carcinoma: A Further Update

“…These patients become candidates for cytoreductive therapy. In the previous report from Indiana University, 1 hepatic resection has been shown to be a safe and efficacious cytoreductive therapy for testicular carcinoma. The purpose of this report is to update the previous work and again to help define the role of surgery for these patients.…”

“…1 Twenty-nine more patients can now be added to this cohort. Between June 1974 and May 1996, 57 patients underwent hepatic resection for treatment of metastatic nonseminomatous germ cell carcinoma.…”