A 25-Year Single Institution Experience With Surgery for Primary Mediastinal Nonseminomatous Germ Cell Tumors

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Abstract

Background: The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT. Methods: A total of 158 patients (mean age, 29 ± 8 years) who underwent postchemotherapy operations for PMNSGCT were reviewed and multiple variables analyzed. Results: Ten (6%) operative deaths occurred, nine of which were attributed to respiratory failure, and 26 (18%) patients experienced postoperative complications, including 9 with respiratory failure. None of 17 recent patients who received chemotherapy regimens that did not contain bleomycin experienced pulmonary complications (p = 0.12 vs patients who received bleomycin). Operative survivors were followed up a median of 34 months (range, 1 to 194 months). Multivariable analysis demonstrated that the postchemotherapy pathologic category of complete necrosis vs teratoma), persistent germ cell or nongerm cell cancer, and elevated serum tumor markers after operation were independently predictive of survival. Conclusions: Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.

Original languageEnglish
Pages (from-to)371-378
Number of pages8
JournalAnnals of Thoracic Surgery
Volume85
Issue number2
DOIs
StatePublished - Feb 2008

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Bleomycin
Survival
Germ Cells
Drug Therapy
Teratoma
Respiratory Insufficiency
Cisplatin
Neoplasms
Necrosis
Tumor Biomarkers
Nonseminomatous germ cell tumor
Survivors
Biomarkers
Lung
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{cca0fa3c76404db99897390e50c0f665,
title = "A 25-Year Single Institution Experience With Surgery for Primary Mediastinal Nonseminomatous Germ Cell Tumors",
abstract = "Background: The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT. Methods: A total of 158 patients (mean age, 29 ± 8 years) who underwent postchemotherapy operations for PMNSGCT were reviewed and multiple variables analyzed. Results: Ten (6{\%}) operative deaths occurred, nine of which were attributed to respiratory failure, and 26 (18{\%}) patients experienced postoperative complications, including 9 with respiratory failure. None of 17 recent patients who received chemotherapy regimens that did not contain bleomycin experienced pulmonary complications (p = 0.12 vs patients who received bleomycin). Operative survivors were followed up a median of 34 months (range, 1 to 194 months). Multivariable analysis demonstrated that the postchemotherapy pathologic category of complete necrosis vs teratoma), persistent germ cell or nongerm cell cancer, and elevated serum tumor markers after operation were independently predictive of survival. Conclusions: Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.",
author = "Kenneth Kesler and Karen Rieger and Hammoud, {Zane T.} and Kruter, {Laura E.} and Susan Perkins and Mark Turrentine and Bryan Schneider and Lawrence Einhorn and John Brown",
year = "2008",
month = "2",
doi = "10.1016/j.athoracsur.2007.09.020",
language = "English",
volume = "85",
pages = "371--378",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
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number = "2",

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TY - JOUR

T1 - A 25-Year Single Institution Experience With Surgery for Primary Mediastinal Nonseminomatous Germ Cell Tumors

AU - Kesler, Kenneth

AU - Rieger, Karen

AU - Hammoud, Zane T.

AU - Kruter, Laura E.

AU - Perkins, Susan

AU - Turrentine, Mark

AU - Schneider, Bryan

AU - Einhorn, Lawrence

AU - Brown, John

PY - 2008/2

Y1 - 2008/2

N2 - Background: The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT. Methods: A total of 158 patients (mean age, 29 ± 8 years) who underwent postchemotherapy operations for PMNSGCT were reviewed and multiple variables analyzed. Results: Ten (6%) operative deaths occurred, nine of which were attributed to respiratory failure, and 26 (18%) patients experienced postoperative complications, including 9 with respiratory failure. None of 17 recent patients who received chemotherapy regimens that did not contain bleomycin experienced pulmonary complications (p = 0.12 vs patients who received bleomycin). Operative survivors were followed up a median of 34 months (range, 1 to 194 months). Multivariable analysis demonstrated that the postchemotherapy pathologic category of complete necrosis vs teratoma), persistent germ cell or nongerm cell cancer, and elevated serum tumor markers after operation were independently predictive of survival. Conclusions: Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.

AB - Background: The treatment of primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) with cisplatin-based chemotherapy, followed by surgical resection of residual disease, has been established. We reviewed our institution's 25-year experience in the cisplatin era to determine surgical risks and predictors of survival after surgery for PMNSGCT. Methods: A total of 158 patients (mean age, 29 ± 8 years) who underwent postchemotherapy operations for PMNSGCT were reviewed and multiple variables analyzed. Results: Ten (6%) operative deaths occurred, nine of which were attributed to respiratory failure, and 26 (18%) patients experienced postoperative complications, including 9 with respiratory failure. None of 17 recent patients who received chemotherapy regimens that did not contain bleomycin experienced pulmonary complications (p = 0.12 vs patients who received bleomycin). Operative survivors were followed up a median of 34 months (range, 1 to 194 months). Multivariable analysis demonstrated that the postchemotherapy pathologic category of complete necrosis vs teratoma), persistent germ cell or nongerm cell cancer, and elevated serum tumor markers after operation were independently predictive of survival. Conclusions: Operative risks for PMNSGCT appear to be improved with the use of chemotherapy regimens that do not contain bleomycin. Patients pathologically demonstrating complete tumor necrosis in the residual mass after chemotherapy have excellent long-term survival, with decreasing survival after resection of teratoma and persistent germ cell or nongerm cell cancer. Patients pathologically demonstrating persistent germ cell or nongerm cell cancer have poor but possible long-term survival, which justifies an aggressive surgical approach in patients who are deemed operable.

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