Hepatic Resection of Metastatic Testicular Carcinoma: A Further Update

Hahn, Tara L.; Jacobson, Lewis E.; Einhorn, Lawrence H.; Foster, Richard S.; Goulet, Robert J.

doi:10.1007/s10434-999-0640-0

Cited by 64 publications

(23 citation statements)

References 16 publications

(20 reference statements)

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“…Previous studies have found necrosis in 16-67%, teratoma in 12-51%, and viable cancer in 21-55%. 8,9,14 In our study, the distribution of these histologies was 33%, 13%, and 27%, respectively, with another 27% being benign hepatic lesions. While no study has specifically examined the role of preoperative hepatic biopsy and the concordance rate between hepatic histology found at preoperative biopsy versus at surgical resection, preoperative hepatic biopsy is only pursued if its findings would alter patient's overall treatment plan.…”

Section: Discussionmentioning

confidence: 85%

“…6, 10-12 Experiences with resection of metastatic disease in the liver, however, have only been reported in four previous studies. 8,9,13,14 The current study demonstrated that (1) resection of hepatic metastases from GCT can be performed safely, (2) hepatic pathology may be discordant with extrahepatic disease and remain difficult to predict, and (3) long-term overall survival can be achieved. Thus, the experiences reported herein support the integration of hepatic metastasectomy into the multidisciplinary care of patients with metastatic GCT.…”

Section: Discussionmentioning

confidence: 92%

“…A variety of hepatic procedures were undertaken, including major hepatectomies (Table 2). Nearly all patients (14,93.4%) underwent concomitant procedures for disease in the retroperitoneum, abdomen, or chest cavity ( Table 2).…”

Section: Operative Interventionsmentioning

confidence: 99%

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Hepatic Metastasectomy for Testicular Germ Cell Tumors: Is it worth it?

You

Leibovitch

Que

2009

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 92%

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Hepatic Metastasectomy for Testicular Germ Cell Tumors: Is it worth it?

You

Leibovitch

Que

2009

Journal of Gastrointestinal Surgery

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“…In a cohort of 2,219 patients with NSGCT, 57 patients underwent hepatic resection after chemotherapy for metastatic testicular cancer. 3 Radical surgical excision of the mature teratoma is the only curative option for these patients. In a series of 30 patients, 24 patients underwent complete excision with only one recurrence compared with recurrences in five of six incompletely removed tumors.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Unfortunately, because of the diffuse involvement of the liver, in some cases, liver resection and other recent modalities for treatment of hepatic tumors are not effective. Liver transplantation (LT) may be the only option with potential for cure in these patients.…”

Section: T He Growing Teratoma Syndrome (Gts) Is Charac-mentioning

confidence: 99%

Liver transplantation for growing teratoma syndrome: Report of a case

Eghtesad

Marsh

Cacciarelli

et al. 2003

Liver Transplantation

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Liver transplantation is a well-established treatment for liver failure and for a selected group of patients with hepatic tumors. The growing teratoma syndrome refers to the phenomenon whereby germ cell tumors enlarge after chemotherapy despite complete eradication of malignant cells and normalization of serum tumor markers. We present the case of a young patient with rapidly growing teratomatous masses in his liver who was treated with liver transplantation from a live donor. We discuss his postoperative management, follow-up, and briefly review literature on the subject. (Liver Transpl 2003;9:1222-1224.)T he growing teratoma syndrome (GTS) is characterized by the enlargement of mixed nonseminomatous germ cell tumors (NSGCTs) after successful chemotherapy with normalization of tumor marker values. 1,2 This syndrome includes patients with enlarging masses in the retroperitoneum or mediastinum and, rarely, liver containing mature teratoma cells. Despite their benign nature, continuous growth of these tumors can potentially cause significant morbidity and possible mortality secondary to their encroachment on adjacent structures in the chest or abdomen. Radical surgical excision of tumors is the only curative option.Involvement of the liver by NSGCTs and transformation to GTS, although rare, has been reported. 3,4 Unfortunately, because of the diffuse involvement of the liver, in some cases, liver resection and other recent modalities for treatment of hepatic tumors are not effective. Liver transplantation (LT) may be the only option with potential for cure in these patients. We report the first case of LT for GTS. Case ReportA 22-year-old man initially presented with a right testicular mass, which he had ignored for 6 months, followed by increasing abdominal girth, right upper-quadrant fullness, and a more than 30-pound weight loss. At evaluation, he was found to have a large testicular mass, as well as multiple metastatic deposits in the liver, hydronephrosis in the right kidney, and retroperitoneal adenopathy with moderate ascites on an abdominal computed tomographic (CT) scan.At presentation serum, alpha-fetoprotein level was 18,300 ng/mL (normal, 0 to 15 ng/mL), and ␤-human chorionic gonadotropin level was 3,840 MIU/mL (normal, 0 to 5 MIU/ mL). The patient underwent a right radical orchiectomy. A pathological diagnosis of mixed germ cell tumor (embryonal carcinoma, 50%; yolk sac tumor, 30%; immature teratoma, 10%; and seminoma, 10%) was established. There was extratesticular extension of the tumor with invasion of the epididymis and focal lymphovascular invasion with negative resection margin. The patient was started on a cisplatin-based chemotherapeutic regimen. After 4 months, the patient underwent retroperitoneal lymphadenectomy, right nephrectomy, and liver biopsy. The specimens showed residual mature teratoma cells without evidence of malignant components in any resected tissue. The patient continued to undergo chemotherapy for another 4 months. Serum tumor marker levels stayed normal, but the hepatic les...

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Multimodality treatment of patients with liver metastases from germ cell tumors

Rivoire

Élias

Cian

et al. 2001

Cancer

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BACKGROUND The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty‐three of 37 patients (62%) were alive with no evidence of disease after a median follow‐up of 66 months (range, 31–134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: the presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. CONCLUSIONS Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure ≤ 10 mm in greatest dimension should be considered for close follow‐up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure ≥ 30 mm in greatest dimension represent a high‐risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10–29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection. Cancer 2001;92:578–87. © 2001 American Cancer Society.

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Hepatic Resection of Metastatic Testicular Carcinoma: A Further Update

Abstract: We conclude that hepatic resection for treatment of metastatic testicular carcinoma is safe and efficacious for all patients except those with elevated marker levels after preoperative chemotherapy.

Cited by 64 publications

References 16 publications

Hepatic Metastasectomy for Testicular Germ Cell Tumors: Is it worth it?

Hepatic Metastasectomy for Testicular Germ Cell Tumors: Is it worth it?

Liver transplantation for growing teratoma syndrome: Report of a case

Multimodality treatment of patients with liver metastases from germ cell tumors

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