Albers Peter, Melchior Diethild, Müller Stefan C
Department of Urology, Bonn University, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
Eur Urol. 2003 Aug;44(2):233-44. doi: 10.1016/s0302-2838(03)00252-5.
Surgery in advanced testicular tumors is an integral part of the multimodality treatment. However, the indications for surgery in testis cancer have changed over the last 10 years. Patients with advanced seminoma only rarely will need surgery after chemotherapy whereas patients with advanced non-seminoma need to undergo the resection of residual disease in most of the cases. Surgery in metastatic disease may even be beneficial for patients with recurrent tumors, patients with persisting marker elevations during chemotherapy, or patients with late relapse of the disease. In view of late relapse, the extent and completeness of the primary resection is an important issue and, therefore, surgery should be performed in specialized centers. Most of the procedures are technically demanding and, therefore, individualized perioperative precautions are necessary to reduce morbidity of surgery. Nevertheless, in individual cases nerve-sparing techniques and laparoscopic approaches may be applicable to reduce surgery-related morbidity. This review will update the current indications and recommendations for post-chemotherapy surgery in advanced testis cancer.
晚期睾丸肿瘤的手术是多模式治疗不可或缺的一部分。然而，在过去10年里，睾丸癌的手术指征发生了变化。晚期精原细胞瘤患者在化疗后很少需要手术，而晚期非精原细胞瘤患者在大多数情况下需要切除残留病灶。转移性疾病的手术甚至可能对复发性肿瘤患者、化疗期间肿瘤标志物持续升高的患者或疾病晚期复发的患者有益。鉴于晚期复发，原发灶切除的范围和完整性是一个重要问题，因此，手术应在专业中心进行。大多数手术技术要求高，因此，需要采取个体化的围手术期预防措施以降低手术并发症。尽管如此，在个别情况下，保留神经技术和腹腔镜手术方法可能适用于降低手术相关并发症。本综述将更新晚期睾丸癌化疗后手术的当前指征和建议。
