Management of post-chemotherapy residual masses in testicular tumor and surgical tecnique

  • Ferhat Ateş
  • Ömer Yılmaz
  • Kadir Vehbi Baykal

Bull Urooncol 2011;10(3):68-74

Understanding of retroperitoneal anatomy, improvement of surgical technique, using of effective chemotherapy regimens have made improvements in the treatment of advanced germ cell testicular tumors last 25 years.

Histological results of retroperitoneal residual masses after chemotherapy are 1- Fibrosis/necrosis 2- Teratoma 3- Viable cancer cells. These three results were equal in previous years but nowadays with the effects of effective chemotherpy treatments percentage of viable cancer cells decrease to 2-15% and teratoma is seen about 35-40%.

In fact teratoma is a benign lesion but in time it can grow locally and press other structures and it can transform to a malignant form as sarcoma or carcinoma so all the residual masses of NSGCT after chemotherapy treatment should be resected totally when the tumor markers decrease normal levels and patient becomes ready for surgery. This is important for overall survival rates.

The retroperitoneal residual masses are analyzed with FDG-PET 6-8 weeks after chemotherapy for viable cancer in advanced seminomas. If the masses include cancer cells RPLND becomes a treatment tool. There is not any tool for predicting tumor viability in residual masses at present days.

In general opinion RPLND made after chemotherapy should be done bilaterally and if possible with nerve sparing technique. Nowadays some authors suggest modified RPLND to decrease morbidity of RPLND and they think that by using modified technique the oncological outcomes will not be different. Mean morbidity rate of this surgery in literature is 20.7%. Most common problems are ileus, vasculary injury, problems of lungs, and wound infections. Because of high morbidity rates and hard surgery technique this operations should be done in experienced centers.

Keywords: Testicular cancer, chemotherapy, RPLND