Cancer reductive surgery. Report on the simultaneous excision of abdominal and thoracic metastases from widespread testicular tumors

Eighteen patients with advanced testicular tumors presenting metastases in the retroperitoneum, the abdomen, the mediastinum and the lungs underwent a simultaneous excision of their abdominal and thoracic metastases in preparation for chemotherapy. A midline incision from the symphysis pubis to the xiphoid process was first done allowing entrance into the abdomen and the retroperitoneal area. Excision of the lesions in these areas was first performed. The wound was then closed and the midline incision was extended to the base of the neck. The sternum was split in half longitudinally allowing entrance into the mediastinum. Both pleural cavities were then opened allowing exploration of the lungs and wedge resections of the pulmonary nodules bilaterally. Fifteen patients tolerated the surgery well. Two patients developed transient respiratory failure and recovered. One patient died in the postoperative period from respiratory insufficiency. The autopsy report indicated pulmonary fibrosis secondary to previous bleomycin therapy. At present, 9 out of 18 patients (50%) are alive with no clinical evidence of disease from 9 months to 39 months (average 26 months), respectively, 6 patients (39%) are dead, 6 patients (33%) died from their tumor several months after surgery, and 1 patient died in the postoperative period. The morbidity of such an approach will be analyzed and the rationale will be discussed. All the patients in this report received chemotherapy with various combinations of bleomycin, vinblastine, vincristine, platinum, adriamycin, cytoxan, and actinomycin D.