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Postchemotherapy Retroperitoneal Surgery Remains Necessary in Patients With Nonseminomatous Testicular Cancer and Minimal Residual Tumor Masses

From the Departments of Medical Oncology, Pathology, Radiology, Surgical Oncology, and Clinical Cancer Research, The Norwegian Radium Hospital, Oslo, Norway.

Address reprint requests to Sophie D. Fosså, MD, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway; e-mail: s.d.fossa{at}klinmed.uio.no.

Purpose: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was 20 mm in diameter after modern cisplatin-based induction chemotherapy.

Patients and Methods: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatin-based induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was 20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND.

Results: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was 10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass.

Conclusion: One third of retroperitoneal postchemotherapy lesions 20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.

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