Surgical treatment of non-seminomatous germinal testes tumors

Surgical management of germinal testes tumors other than seminoma is presented. Phase I consists of removal of the primary tumor; Phase II, the surgical removal of retroperitoneal metastatic diseases; and Phase III, surgical management of chest metastasis. Seventy-two patients were explored with the intent of performing a simultaneous bilateral retroperitoneal lymphadenectomy. Each had a radical orchiectomy prior to exploration. Seven patients were found unresectable because of extensive disease above the renal pedicle and lymphadenectomy was not performed. The1 remaining 65 were found resectable and a transabdominal bilateral retroperitoneal lymphadenectomy was done. Of this number, 20 or 30% had metastatic nodes. No other treatment was used. All had a 3-year followup and 53 were followed for 5 years or more. The 3-year survival for Stage I is 93%, and for Stage II, 75%. Five-or-more-year survival in Stage I is 86% and Stage II, 70%. Other published series of equivalent number, pathology and staging are mentioned and discussed concerning the advantages and disadvantages of unilateral versus bilateral dissection. Our limited experience in the surgical management of Stage III lesions is mentioned. Thus, this experience with pathologic Stage II cases, both in our series and those of others, clearly demonstrates the capability of surgery as a primary treatment to control 70% of patients with retroperitoneal lymph node metastases. This surgical technique is therefore recommended as primary therapy in Stage I and II non-seminomatous germinal testes tumors.