The following is a summary of “Discordance of retroperitoneal and thoracic histologic findings in patients with metastatic germ cell tumors at postchemotherapy residual tumor resection,” published in the July 2024 issue of Surgery by Che et al.

Postchemotherapy residual tumor resection (PC-RTR) is a critical component in the multimodal treatment strategy for patients with metastatic germ cell tumors. In cases of simultaneous retroperitoneal and thoracic metastases, consecutive surgical interventions are often necessary. 

This study evaluates the histologic outcomes following both abdominal and thoracic surgeries to optimize the sequence and intensity of these procedures. 

From a cohort of 671 PC-RTRs (2008 and 2021), researchers focused on 50 patients with stage III non-seminomatous germ cell tumor (NSGCT) who underwent both retroperitoneal and thoracic PC-RTR after receiving first-line and salvage chemotherapy. 

All patients in the subset had stage III NSGCT, with 39 patients receiving first-line chemotherapy and 11 patients receiving salvage chemotherapy. Of these, 45 patients (90%) underwent retroperitoneal resection prior to thoracic surgery, 3 patients (6%) had thoracic surgery before retroperitoneal surgery, and 2 patients (4%) had simultaneous surgeries. Notably, histologic findings between retroperitoneal and thoracic specimens were discordant in 23% of cases. Among patients treated with first-line chemotherapy, 14 patients showed necrosis in retroperitoneal histology, but 4 of these had viable carcinoma in lung histology. Conversely, in patients with teratoma in the retroperitoneum, thoracic findings were concordant in 78% of cases, with 100% concordance when teratomatous elements were also present in the orchiectomy specimen. However, after salvage chemotherapy, the rate of histologic discordance increased to 55%. 

These findings underscored that necrotic retroperitoneal residual masses were unreliable predictors of thoracic histology. Patients with teratoma in the retroperitoneum exhibited a high likelihood of teratoma in thoracic specimens, suggesting that histologic concordance was more predictable in these cases. This study highlighted the necessity of individualized surgical planning based on the histologic characteristics of residual tumours to enhance treatment efficacy and outcomes for patients with metastatic germ cell tumours.

Source: wjso.biomedcentral.com/articles/10.1186/s12957-024-03467-6