Surgical Management of Post-Chemotherapy Residual Testis Tumor

  • Randall G. Rowland
  • Michael A. S. Jewett
Part of the Cancer Treatment and Research book series (CTAR, volume 19)


In considering the management of residual testis cancer after chemotherapy, one needs to review the previous modes of therapy of advanced testis cancer as well as review the changes in chemotherapy and staging procedures which have allowed the mode of therapy to evolve to its current day form increasing survival from 5–10% a decade ago to greater than 80% at this time. Each of these aspects will be considered in turn followed by current recommendations for workup of the patient and for evaluation of the patient after completion of chemotherapy. Also the preoperative preparations will be discussed along with intraoperative surgical considerations and postoperative management. The results of this combined treatment regimen will be considered as well as the complications of the treatment. Finally, an overall flow sheet of the management of patients with disseminated testis cancer will be presented. This flow sheet emphasizes the indications for surgery and its interrelationship with chemotherapy for advanced seminoma as well as non-seminomatous germ cell testis tumors.


Partial Remission Testicular Cancer Testicular Tumor Salvage Chemotherapy Compute Axial Tomographic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Merrin C, Takita H, Weber R, Wajsman Z, Baumgartner G, Murphy GP: Combination radical surgery and multiple sequential chemotherapy for the treatment of advanced carcinoma of the testis (stage III). Cancer 37:2029, 1976.CrossRefGoogle Scholar
  2. 2.
    Donohue JP: Surgical management of testis cancer. In: Testicular Tumors: Management and Treatment, Einhorn LH (ed). New York: Masson Publishing USA Inc, pp 29–46, 1980.Google Scholar
  3. 3.
    Donohue JP, Rowland RG: Complications of retroperitoneal lymph node dissection. J Urol 125:338–340, 1981.PubMedGoogle Scholar
  4. 4.
    Einhorn LH, Donohue JP: Chemotherapy for disseminated testicular cancer. Urol Clin North Am 4(3):407–426, 1977.PubMedGoogle Scholar
  5. 5.
    Merrin C, Bleckley S, Takita H: Multimodal treatment of advanced testicular tumor with reductive surgery and multisequential chemotherapy with cis-platinum, bleomycin, vinblastine, vincristine and actinomycin D. J Urol 120:73–76, 1978.PubMedGoogle Scholar
  6. 6.
    Li MC, Whitmore WF, Golbey R, Grabstald H: Effects of combined drug therapy on metastatic cancer of the testis. JAMA 174:145–153, 1960.Google Scholar
  7. 7.
    Samuels ML, Howe CD: Vinblastine in the management of testicular cancer. Cancer 25:1009–1017, 1970.PubMedCrossRefGoogle Scholar
  8. 8.
    Kennedy BJ: Mithramycin therapy in advanced testicular neoplasms. Cancer 26:755–766, 1970.PubMedCrossRefGoogle Scholar
  9. 9.
    Blum RH, Carter S, Agre K: A clinical review of bleomycin — a new antineoplastic agent. Cancer 31:903–914, 1973.PubMedCrossRefGoogle Scholar
  10. 10.
    Wyatt JK, McAninch LH: A chemotherapeutic approach to advanced testicular carcinoma. Can J Surg 10:421–426, 1967.PubMedGoogle Scholar
  11. 11.
    Samuels ML, Lanzotti VJ, Holoye PY, Boyle LE, Smith TL, Johnson DE: Combination chemotherapy in germinal cell tumors. Cancer Treat Rev 3:185–204, 1976.PubMedCrossRefGoogle Scholar
  12. 12.
    Wittes RE, Yagoda A, Silvay O, Magill GB, Whitmore W, Krakoff IH, Golbey RB: Chemotherapy of germ cell tumors of the testis. Cancer 37:637–645, 1976.PubMedCrossRefGoogle Scholar
  13. 13.
    Cvitkovic E, Cheng E, Whitmore WF Jr et al.: Germ cell tumors. Chemotherapy update. Proc Am Assoc Cancer Res 18:324, 1977.Google Scholar
  14. 14.
    Rosenberg B, VanCamp L, Krigas T: Inhibition of cell division in E. coli by electrolysis products from a platinum electrode. Nature 205:678–699, 1965.CrossRefGoogle Scholar
  15. 15.
    Highby DJ, Wallace HJ, Albert DJ, Holland JF: Diaminodichloroplatinum: a phase I study showing responses in testicular and other tumors. Cancer 33:1219–1225, 1974.CrossRefGoogle Scholar
  16. 16.
    Einhorn LH, Donohue JP: Cis-diamminedichloroplatinum, vinblastine and bleomycin chemotherapy in disseminated testicular cancer. Ann Intern Med 87:293–298, 1977.PubMedGoogle Scholar
  17. 17.
    Einhorn LH, Williams SD: The management of disseminated testicular cancer. In: Testicular Tumors: Management and Treatment, Einhorn LH (ed). New York: Masson Publishing USA Inc, pp 117–149, 1980.Google Scholar
  18. 18.
    Einhorn LH: Testicular cancer. In: Medical Oncology, Schiein P, Calabres P (eds). New York City: MacMillan (in press).Google Scholar
  19. 19.
    Vugrin D, Whitmore WF Jr, Golbey RB: Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum combination chemotherapy in metastatic testis cancer — a 1-year program. J Urol 128:1205–1208, 1982.PubMedGoogle Scholar
  20. 20.
    Williams RD, Feinberg SB, Knight LC, Fraley EE: Abdominal staging of testicular tumors using ultrasonography and computed tomography. J Urol 123:872–875, 1980.PubMedGoogle Scholar
  21. 21.
    Richie JP, Garnick MB, Finberg H: Computerized tomography: how accurate for abdominal staging of testis tumors? J Urol 127:715–717, 1982.PubMedGoogle Scholar
  22. 22.
    Rowland RG, Weisman D, Williams SD, Einhorn LH, Klatte EC, Donohue JP: Accuracy of preoperative staging in stages A and B non-seminomatous germ cell testis tumors. J Urol 127:718–720, 1982.PubMedGoogle Scholar
  23. 23.
    Gitlin D, Boesman M: Serum alpha-fetoprotein, albumin, and gammaglobulin in the human conceptus. J Clin Invest 45:1826–1838, 1966.PubMedCrossRefGoogle Scholar
  24. 24.
    Lange PH, McIntire KR, Waldman TA: Tumor markers in testicular tumor: current status and future prospects. In: Testicular Tumors: Management and Treatment, Einhorn LH (ed). New York: Masson Publishing USA Inc, pp 69–81, 1980.Google Scholar
  25. 25.
    Javadpour N: The National Cancer Institute’s experience with testicular cancer. J Urol 120:651–659, 1978.PubMedGoogle Scholar
  26. 26.
    Donohue JP: Retroperitoneal lymphadenectomy: the anterior approach including bilateral supra-hilar dissection. Urol Clin North Am 4(3):509–521, 1977.PubMedGoogle Scholar
  27. 27.
    Donohue JP, Roth LM, Zachary JM, Rowland RG, Einhorn LH, Williams SG: Cytoreductive surgery for metastatic testis cancer: tissue analysis of retroperitoneal masses after chemotherapy. J Urol 127:1111–1114, 1982.PubMedGoogle Scholar
  28. 28.
    Donohue JP, Einhorn LH, Williams SD: Cytoreductive surgery for metastatic testis cancer: considerations of timing and extent. J Urol 123:876–880, 1980.PubMedGoogle Scholar
  29. 29.
    Mandelbaum I, Williams SD, Einhorn LH: Aggressive surgical management of testicular carcinoma metastatic to lungs and mediastinum. Ann Thor Surg 30:224–229, 1980.CrossRefGoogle Scholar
  30. 30.
    Mandelbaum I, Yaw PB, Einhorn LH, Williams SD, Rowland RG, Donohue JP: The importance of one-stage median sternotomy and retroperitoneal node dissection in disseminated testicular cancer. Presented at Soc of Thoracic Surgeons, San Francisco, January 1983. Ann Surg 36:524–528, 1983.Google Scholar
  31. 31.
    Richie JP: Personal communication.Google Scholar
  32. 32.
    Bracken RB, Johnson DE, Frazier OH, Logothetis CJ, Trindade A, Samuels ML: The role of surgery following chemotherapy in stage III germ cell neoplasms. J Urol 129:39–43, 1983.PubMedGoogle Scholar
  33. 33.
    Skinner DG, Melamed A, Lieskovsky G: Complications of thoracoabdominal retroperitoneal lymph node dissection. J Urol 127:1107–1110, 1982.PubMedGoogle Scholar
  34. 34.
    Rowland RG, Moorthy SS, Donohue JP: Anesthetic considerations for post-chemotherapy radical retroperitoneal lymph node dissection. Presented North Central Section American Urological Association, Marco Island, Florida, October 1982.Google Scholar
  35. 1.
    Comisarow RH, Grabstald H: Re-exploration for retroperitoneal lymph node metastases from testis tumor. J Urol 115:569–571, 1976.PubMedGoogle Scholar
  36. 2.
    Javadpour N, Ozols RF, Anderson T, Barlock AB, Wesley R, Young RC: A randomized trial of cytoreductive surgery followed by chemotherapy versus chemotherapy alone in bulky stage III testicular cancer with poor prognostic features. Cancer 50:2004–2010, 1982.PubMedCrossRefGoogle Scholar
  37. 3.
    Goldiner PL, Schweizer O: The hazards of anesthesia and surgery in bleomycin-treated patients. Semin Oncol 6:121–124, 1979.PubMedGoogle Scholar
  38. 4.
    Hendry WF, Goldstraw JE, Husband JE, Barrett A, McElwain TJ, Peckham MJ: Elective delyaed excision of bulky para-aortic lymph node metastases in advanced non-seminoma germ cell tumours of testis. J Urol 53:648–653, 1981.CrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers, Boston 1984

Authors and Affiliations

  • Randall G. Rowland
  • Michael A. S. Jewett

There are no affiliations available

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