P2.17-003 Is Complete Resection Mandatory for Mediastinal Germ Cell Tumor Which Shows Severe Adhesion to Greater Vessels?

Abstract

Surgical resection for mediastinal germ cell tumors is one of important modality to cure. But it sometimes shows severe adhesion to greater vessels, complete resection without vessel replacement is difficult. But, no viable cells are found in the resected specimen in many cases. Is vessel replacement really needed for this situation? The aim of this study is to confirm whether complete resection is really needed for mediastinal germ cell tumor. The data of 13 patients with resected mediastinal germ cell tumor were retrospectively analyzed for recurrence. Median follow up period was 72.2 months. All cases were male. Mean age was 33.1 years old. Pathological diagnosis was mature teratoma in 5 cases, seminoma in 5 and non-seminomatous malignant germ cell tumor in 3. Seven cases received preoperative chemotherapy. Mean tumor size before surgery was 7.1cm. Median sternotomy was performed in 10 cases and posterolateral approach in 3 cases. Mean operative time was 225 minutes and blood loss was 228 g. Mean postoperative in-hospital duration was 8.2 days. There were not any life-threatening postoperative complications. Macroscopic residual tumor (R2) was found in 5 cases; 2 mature teratoma and 2 seminomas and a germ cell tumor because of severe adhesion to aorta. Four cases received adjuvant therapy. But in R2 case; 2 of mature teratoma and a seminoma without viable cell did not receive adjuvant therapy. Only a case of non-seminoma with complete resection, which did not achieve negative tumor marker preoperatively, showed distant metastases 4 months later after surgery. The surgery for mediastinal germ cell tumor in selected situation can show good survivability without recurrence. To balance the invasiveness and curability, minimizing the extent of surgery; not performing greater vessel replacement is one of choice.