Long-term results of surgical treatment of pulmonary metastases in germ cell testicular cancer patients

Lung metastasectomy as a treatment option in pulmonary metastases has been discussed for a long time.Testicular cancer belongs to a group of tumours primarily treated with chemotherapy because of the high efficacy of anticancer chemotherapy. Surgical treatment plays only a secondary role in the removal of residual pulmonary metastases. Decision-making in the treatment of pulmonary metastases requires histological investigation.The aim of this prospective clinical study is to evaluate 20 years of experience with the surgical treatment of pulmonary metastases in germ-cell testicular cancer. In the period 1988-2008, 63 patients were surgically treated for residual pulmonary metastases of testicular germ-cell tumours. All of the patients were indicated for surgery--pulmonary metastasectomy after the anticancer chemotherapy had been carried out.The survival rate of patients was evaluated according to the Kaplan-Meier method. In total, 57 thoracotomies and 27 sternotomies were performed. 9 patients underwent repeated thoracotomy due to recurrent metastases. In the case of primary resection of pulmonary metastases, minor procedures dominated--atypical partial resections were performed in 84% of all patients. Postoperative mortality was 1.2%. The histological result of metastasis determined a further procedure. Patients in whom vital tumorous tissue was detected (16% of patients) were subsequently treated by second-line chemotherapy, while the rest of the patients were strictly followed-up. In long-term survival, where the mean duration of follow-up was 8.9 years, an almost 60% remission rate was achieved. Based on the long-term results, the authors consider surgical treatment of pulmonary metastases of testicular germ-cell tumours as the treatment fully indicated.