Highlights
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Few studies have examined outcomes after intrathoracic metastasectomy for nonseminomatous testicular germ cell tumors.
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Integration of local and systemic therapies yields favorable outcomes with low morbidity and mortality.
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Surgical management should be considered after chemotherapy, as histology prediction for metastatic lesions remains challenging.
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This study highlights the importance of aggressive surgical approaches in improving long-term survival in young patients with testicular NSGCT.
Abstract
Introduction
Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates.
Methods
Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method.
Results
Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality.
Conclusion
Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.
Keywords
Nonseminomatous germ cell tumor; Chemotherapy; Metastasis; Teratoma; Thoracic surgery; Mortality
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