Complications of postchemotherapy residual tumor resection in patients with germ cell cancer

Abstract

e16077 Background: Residual tumor resection (RTR) is mandatory in all patients with advanced germ cell tumors and visible residual disease after chemotherapy. Full bilateral RTR is the proposed standard of care. However, in lately published series, the rate of nerve-sparing procedures was only 40%. Stage-related RTR may decrease surgical complications, enhance the rate of postoperative antegrade ejaculations and may not compromise oncological efficacy. Methods: A retrospective analysis of 98 patients in a tertial referral center with RTR (2003–2008) was performed using the RTR database and patients´ charts to correlate the extent of surgery to complications and outcome. Results: 49% of patients initially had IGCCCG intermediate and poor prognosis features. In 34%, residual tumor diameter was >5 cm. With a median age of 33 yrs (17–65), the median time of surgery was 210 min (90–604) with a median blood loss of 500 cc (50–5000). In 25 of 98 patients a full bilateral RTR was necessary to remove all residual tumors. The median residual tumor diameter in patients with full bilateral RTR without nerve-sparing was 10.9 cm (1.5–30) as opposed to 4.3 cm (0.5–20) in patients with modified template and/or nerve-sparing approaches (not significant). In 10 pts a nephrectomy and in 9 pts a resection of the vena cava was necessary. Only 2 of each had a bilateral RTR. All CTCAE grade III/VI complications like intraoperative hemorrhage (n=25, 11/25 bilateral RTR), postoperative lymphocele (n=8, 6/8 bilateral RTR), and retrograde ejaculation (15% with modified template and/or nerve-sparing, 100% with bilateral RTR) were significantly correlated with the residual tumor size and with the field of resection. Four patients relapsed, one had an in-field relapse after a template resection. One patient died due to a postoperative aorto-duodenal fistula. Conclusions: The complication rate of RTR is strongly related to the median residual tumor size and the extent of surgery. A full bilateral resection in all patients may result in unnecessary complications in a considerable cohort of patients. The field of resection should be adapted to the primary localization of disease and full bilateral resections should be performed only in patients with bilateral disease. No significant financial relationships to disclose.