Surgical management and outcomes of patients with bone metastases in germ cell tumors: A case series

Abstract

ObjectiveTo report perioperative and oncological outcomes of patients with nodal and bone involvement treated with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and simultaneous bone resection (BR). Patients and methodsBetween 2008 and 2016, 14 consecutive unselected TC patients with nodal and bone involvement underwent PC-RPLND and BR. Surgery was performed together with orthopedic surgeons. Standard PC-RPLNDs were performed in 4 patients. Bilateral template PC-RPLND was carried out in 10 patients. Complete BR combined with spacer implantation (XPand Cage) and posterior stabilization was performed in 6 patients. Instead, 8 patients were submitted to partial BR. Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications. Disease recurrence and mortality were registered. ResultsMean operative time, blood loss, and length of hospital stay were 295 minutes, 3.7, l, and 13 days. Additional oncological surgery was performed on 5 patients. Overall, 9 patients had adjunctive surgeries or intraoperative complications. Pathologic report consisted of teratoma in 6, cancer in 5, necrosis in 3 patients. Overall, 2, 5, and 1 patients had Clavien I, II, and IIIA complications, respectively. No perioperative mortality was recorded. Disease recurrence and death occurred in 8 and 7 patients. ConclusionsPC-RPLND and BR is a safe, feasible, and challenging procedure. Availability of an orthopedic surgeon and stabilization of the spine are mandatory. Complete BR has therapeutic impact on patients harboring teratoma, partial BR seems to be beneficial in patients with necrosis. Patients with vital tumor will relapse irrespectively of the BR approach.