Does necrosis on frozen-section analysis of a mass after chemotherapy justify a limited retroperitoneal resection in patients with advanced testis cancer?

OBJECTIVE: To evaluate morbidity and relapse in patients with advanced testis cancer who underwent a post-chemotherapy resection of a residual mass and a limited retroperitoneal lymph node dissection. PATIENTS AND METHODS: A total of 62 patients underwent complete resection of retroperitoneal masses after chemotherapy and a limited lymph node dissection if frozen sections of the mass showed necrosis (37 patients) or a bilateral dissection if the frozen section indicated viable germ cell tumour or teratoma (25 patients).
RESULTS: With a median follow-up of 6 years, 14 (23%) patients relapsed, but only one within the retroperitoneum (teratoma) after a limited lymphadenectomy. There was a concordance of 89% between the frozen section of the post-chemotherapy mass and the permanent-section histological diagnosis of the entire lymphadenectomy specimen. Of the 37 patients whose masses showed necrosis on frozen section, three had viable germ cell tumour and one had teratoma on final histology. In all four false-negative cases, residual tumour was confined to the resected mass. Six patients (10%) had surgical complications (one after limited and five after bilateral lymph node dissection).
CONCLUSION: The surgical resection of all residual masses after chemotherapy, followed by limited retroperitoneal lymphadenectomy if frozen-section analysis shows necrosis, is a safe approach in selected patients with advanced testicular cancer.