Modified Neck Dissection for Metastatic Nonseminomatous Testicular Carcinoma

Abstract

Objective: To examine the role of neck dissection in the treatment of metastatic stage 3 nonseminomatous germ-cell tumors (NSGCTs) of testicular origin. Method: A retrospective review was made of 45 patients with metastatic NSGCT who underwent 48 unilateral and 3 bilateral neck dissections. Only level III-VI nodes were dissected, often with concomitant or staged mediastinal dissection, thoracotomy, and/or retroperitoneal node dissection. Occasionally, resection of the clavicle, jugular vein, or subclavian artery, or a combination of these, was required to eradicate the disease. Results: There were only four instances of recurrence in dissected necks. There was one case of dedifferentiation of mature teratoma to adenocarcinoma. Patients who were followed for a mean period of 32 months had a disease-free survival of 72%. Prognosis for patients with stage 3 disease but negative preoperative tumor markers (α-fetoprotein and human chorionic gonadotropin) was excellent, with 97% of these patients having no evidence of disease at follow-up. Factors having a negative impact on survival included positive tumor markers, elements of germ-cell cancer in excised nodes, and a neck mass that represents late relapse of disease. Conclusion: Modified neck dissection has a demonstrated role in the treatment of metastatic NSGCT. It prevents reversion of mature teratoma to malignant germ cell tumor with minimal morbidity. Aggressive resection of disease is indicated, often in conjunction with thoracic surgery, to eradicate disease extending into the chest. There is an excellent prognosis in patients with negative preoperative serologic tumor markers.