睾丸腫瘍の後腹膜Bulky腫瘍切除術

Abstract

Recently, combination chemotherapy of bleomycin, vinblastine and cis-dichlorodiamineplatinum has dramatically advanced the treatment of metastatic testicular tumors. However, we believe that solid malignant tumors should be reduced surgically as much as possible. Twelve patients underwent surgery to resect a bulky metastatic mass of testicular tumor in the retroperitoneum 4 to 36 days (average, 18 days) after beginning combination chemotherapy or irradiation. The bulky tumors were successfully resected in all patients except one who underwent partial resection. Resected tumors were 59g on the average (20-170 g). Surgery lasted for an average of 4 hours 20 minutes (2 hours 40 minutes – 6 hours 30 minutes). As combined surgery, I patient had nephrectomy, 1 patient had partial gastrectomy, 2 patients had resection of supraclavicular metastatic tumors and 1 patient had vena cava inferior removed. Mesenteric inferior artery was ligated in 7 patients, 2 of whom complained of severe diarrhea for 7 days postoperatively. Postoperative complications were ileus in 2 patients, hydronephrosis in I patient and loss of emission in 5 patients. With additional combination chemotherapy and irradiation following the reductive surgery, 10 patients (83%) with seminoma, embryonal carcinoma or teratoma immature have been continuously free of disease for 13-56 months (average, 28 months), one patient with reticulum cell sarcoma died of sepsis due to chemotherapy at 9 months after reductive surgery and the last patient with embryonal carcinoma and seminoma is alive although in partial remission of lung metastasis at 3 months after surgery.