Re-Exploration for Retroperitoneal Lymph Node Metastases from Testis Tumors

Abstract

Prognosis has been poor for patients with retroperitoneal metastases from nonseminomatous testis tumors that are initially unresectable and persist after chemotherapy and irradiation or those that recur after initial lymphadenectomy. Eleven such patients had re-explorations and are described. In 4 patients only histologically benign teratoma and/or fibrosis was found. The presence of a retroperitoneal mass in these circumstances does not necessarily mean that malignant tissue was present. The procedure provided an accurate diagnosis in all patients and permitted the elimination or reduction of subsequent chemotherapy or radiation in 4 patients who had no tumor. Five of 7 patients with symptoms caused by bulky masses were improved and 3 patients with unresectable disease had radiopaque markers placed to facilitate subsequent radiotherapy. The operation was often difficult because of retroperitoneal adhesions from previous treatment but there was no significant morbidity and no mortality. Nine patients survived from 6 mo. to 4 yr and 7 have no evidence of disease. Two patients died of recurrent tumor 2 and 9 mo. after re-exploration. A good prognosis was indicated if the mass found at re-exploration was completely resectable and contained only histologically benign teratoma and/or fibrous tissue. Re-exploration should be considered for selected patients with testis tumors who have a retroperitoneal mass that appears after initial lymphadenectomy and persists after interval chemotherapy or radiation therapy and retroperitoneal metastases that are initially unresectable and persist after subsequent chemotherapy or radiation therapy.