What are germ cell tumors?
Germ cell tumors originate from the cells that produce eggs or sperm. Although they most commonly occur in the testicles (in men) or ovaries (in women), they can also appear in other locations.
When they spread, they frequently affect the retroperitoneum (the space behind the abdominal cavity where the aorta, vena cava, and abdominal lymph nodes are located).
Treatment
The standard treatment for germ cell tumors with retroperitoneal involvement usually follows this sequence:
- Chemotherapy: Usually cisplatin-based, it is the first line of treatment.
- Evaluation: After chemotherapy, it is evaluated whether tumor masses remain.
- Surgery: If there is residual disease, post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) may be needed.
Post-chemotherapy surgery
After chemotherapy, residual masses may remain that need to be surgically removed:
- Necrosis/fibrosis: In many cases, what remains is "dead" tissue, but only surgery can confirm this.
- Teratoma: Mature tumor that does not respond to chemotherapy and must be removed.
- Viable tumor: In some cases, active tumor cells remain.
It is impossible to know for sure what the masses contain without surgically removing and analyzing them.
The surgery
Retroperitoneal lymph node dissection is a complex surgery that requires an experienced team:
- Incision: Usually a midline or subcostal abdominal incision.
- Resection: All residual tumor masses are removed.
- Vessel management: May require working around the aorta and vena cava.
- Possible additional resections: Sometimes affected adjacent organs need to be removed.
- Duration: 3-8 hours depending on complexity.
Possible complications
- Retrograde ejaculation: In men, nerves controlling ejaculation may be affected. Nerve-sparing techniques are used when possible.
- Vascular injury: Although uncommon with experienced surgeons.
- Chylous ascites: Accumulation of lymphatic fluid, usually temporary.
- Intestinal injury: If there are adhesions from previous chemotherapy.
Results
Germ cell tumors have excellent cure rates, even in advanced stages:
- Cure rates above 80-90% in many cases.
- Complete surgery is key to long-term success.
- Close follow-up with tumor markers and imaging.
It is essential to have the surgery performed by a team with experience in this type of complex surgery.
Recovery
- Hospitalization: 5-10 days depending on surgery extent.
- Feeding: Gradually reintroduced.
- Normal activities: 4-6 weeks.
- Follow-up: Tumor markers and periodic CT scans.
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