# Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer

## TL;DR

Surgery after chemotherapy improves long-term survival in young patients with nonseminomatous testicular cancer metastases.

## Contribution

Demonstrates that aggressive surgical approaches after chemotherapy significantly improve survival in NSGCT patients with thoracic metastases.

## Key findings

- 10-year survival rate after thoracic metastasectomy was 94.3% with no surgical-related mortality.
- Multimodality treatment combining systemic therapy and radical surgery offers high cure rates for thoracic metastatic NSGCT.
- Teratoma was the predominant pathology in metastatic lesions, highlighting challenges in histology prediction.

## Abstract

•Few studies have examined outcomes after intrathoracic metastasectomy for nonseminomatous testicular germ cell tumors.•Integration of local and systemic therapies yields favorable outcomes with low morbidity and mortality.•Surgical management should be considered after chemotherapy, as histology prediction for metastatic lesions remains challenging.•This study highlights the importance of aggressive surgical approaches in improving long-term survival in young patients with testicular NSGCT.

Few studies have examined outcomes after intrathoracic metastasectomy for nonseminomatous testicular germ cell tumors.

Integration of local and systemic therapies yields favorable outcomes with low morbidity and mortality.

Surgical management should be considered after chemotherapy, as histology prediction for metastatic lesions remains challenging.

This study highlights the importance of aggressive surgical approaches in improving long-term survival in young patients with testicular NSGCT.

Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates.

Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method.

Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality.

Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.