進行精巣腫瘍に対する救済外科療法(Salvage surgery)の検討

概要

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救済外科療法の施行にあたっては安易な手術適応を避け,十分な術前化学療法などを行い,残存病巣を壊死,奇形腫に導き,完全切除すべきである。残存癌例に対しては,術後の再発の危険性が非常に高いため,十分な術後化学療法が必要であるTwenty-seven patients with advanced testicular cancer underwent cisplatin-based combination chemotherapy and followed by salvage surgery. Complete necrosis and/or fibrosis (necrosis) was found in 12 (44%) operative specimens, mature teratoma in 5 (19%) and residual cancer in 10 (37%) patients. Ten of the 12 (83%) patients with necrosis and all 5 with mature teratoma were rendered disease-free (NED). Only 6 of the 10 (60%) patients with residual cancer were continuously NED. These findings suggest that if carcinoma is found in the resected specimen, further salvage chemotherapy is required. Salvage surgery should be avoided in patients with elevated serum tumor marker levels.