Presentation Authors: Gregory Nason*, Laura Donahoe, Ishan Aditya, Marc De Perrot, Lynn Anson-Cartwright, Michael Jewett, Aaron Hansen, Philippe Bedard, Padraig Warde, Peter Chung, Joan Sweet, Martin O'Malley, Robert Hamilton, Toronto, Canada
Introduction: Resection of residual masses (>1cm) after chemotherapy is recommended in patients with testicular non-seminomatous germ cell tumor (NSGCT). Traditionally, resections in the abdomen and chest are performed as separate surgical procedures. The aim of this study was to compare a simultaneous versus a sequential approach to residual mass resections.
Methods: A retrospective review was performed of all patients who underwent both retroperitoneal and thoracic resection of post chemotherapy residual masses at the Princess Margaret Cancer Centre between 2002 and 2018. Patients were divided into two groups: Group 1- Simultaneous (Combined Retroperitoneal and Thoracic resections at the same sitting) Group 2: Sequential (Retroperitoneal and Thoracic resections at separate dates).
Results: During the study period, 35 simultaneous and 17 sequential resections were performed. The mean age of patient at surgery was 28 years (Range 16-61). The mean follow up from final surgery was 48.3 months (Range 1-239). Histology revealed teratoma in 38 (73.1%) patients, necrosis in 8 (15.4%) and viable tumor in 6 (11.5%). Discordant pathology findings between thoracic and abdominal resections were noted in 16 (30.8%) patients. There was no difference in overall mean length of operating time (mins) between the two groups (635 mins vs 405mins + 218mins, p=0.77). There was no difference in overall blood loss (mls) between the two groups (1904 mls vs 2258mls + 301mls, p=0.39). There was no difference in overall mean length of stay (days) between the two groups (14.8 days vs 9.5days + 8.2days, p=0.72).Patients who underwent sequential surgeries had a longer time from consent to completion of completion of surgery (8.4 months vs 2.1 months, p=0.0001).Overall, there was a recurrence rate of 30.8% (n=16). Two patients have died of testicular cancer.
Conclusions: Simultaneous resection of retroperitoneal and thoracic post chemotherapy metastases is a feasible and safe approach. It does entail multidisciplinary co-operation and a longer primary procedure.