The role of thoracotomy in managing postchemotherapy residual thoracic masses in patients with nonseminomatous germ cell tumours

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Abstract
The role of thoracotomy in patients with metastatic testicular cancer is explored by the group from Memorial Sloan‐Kettering Cancer Center. This is a controversial area, and they evaluate the outcome and establish prognostic variables in patients having this procedure after chemotherapy. They found it to be therapeutic for most patients with teratoma, and many with residual viable cancer. The group from the University of Miami evaluated the use of cell‐saver in patients undergoing radical prostatectomy and reassure the reader that its use does not influence the recurrence of cancer. In another interesting study from Hamburg, the authors show that there are important differences in the biopsy features between prostate cancers located in the transition and peripheral zones. In a detailed study, authors from Poitiers show in a case‐control study that obesity was not significantly associated with prostate cancer when compared to controls with BPH, but obese men had a higher risk of having prostate cancer. Objective: To evaluate the clinical outcome and identify prognostic variables in patients with nonseminomatous germ cell tumours undergoing postchemotherapy thoracotomy for residual masses, as the role of this procedure is controversial.Patients and methods: Of 385 patients who underwent postchemotherapy retroperitoneal lymph node dissections between 1988 and 1998, 105 also had 130 thoracotomies. The clinical presentation, chemotherapy regimens, marker status, primary tumour histology, pathology of all resected masses, and clinical outcome of these 105 patients were analysed.Results: The overall discordance rate for synchronous thoracic and retroperitoneal masses was 28%; that for asynchronous thoracic and retroperitoneal masses was 57%. Independent prognostic factors for residual thoracic teratoma or cancer were teratoma (mature or immature) in the primary tumour or retroperitoneal teratoma or cancer. Although three of 12 patients with residual thoracic cancer remained with no evidence of disease, residual thoracic cancer is an independent prognostic factor (P < 0.001) against disease‐free survival.Conclusion: Postchemotherapy thoracotomy yields important prognostic information, and is therapeutic for most patients with teratoma and a subset with residual viable cancer. The prognostic criteria predictive of fibrosis are not sufficiently accurate to omit resection of residual thoracic masses.

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