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Ann Thorac Surg 2004;78:1224-1228
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Short- and Long-Term Outcomes after Large Pulmonary Resection for Germ Cell Tumors After Bleomycin-Combination Chemotherapy

^a Department of Surgery, Thoracic Division, Indiana University School of Medicine, Indianapolis, Indiana, USA
^b Department of Medicine, Oncology Division, Indiana University School of Medicine, Indianapolis, Indiana, USA

Accepted for publication March 30, 2004.

^* Address reprint requests to Dr Kesler, Indiana University School of Medicine, Department of Surgery, Thoracic Division, 545 Barnhill Dr, EH 215, Indianapolis, IN, USA 46202
kkesler{at}iupui.edu

BACKGROUND: Treatment of nonseminomatous germ cell tumors frequently requires bleomycin-combination chemotherapy followed by resection of residual disease. Bleomycin administration however raises concerns with respect to postoperative respiratory complications, particularly for patients undergoing large pulmonary resections. We undertook an institutional review to determine the outcome of large pulmonary resections after bleomycin-combination chemotherapy.

METHODS: Between 1981 and 2001, 530 patients presented to our institution for resection of residual intrathoracic disease for either metastatic testicular or primary mediastinal nonseminomatous germ cell tumors. We subsequently reviewed 32 of these patients who required pneumonectomy (n = 19; right = 9, left = 10) or bilobectomy (n = 13) after bleomycin-combination chemotherapy.

RESULTS: There were four operative deaths (13%). All postoperative deaths occurred in patients undergoing right-sided resections (pneumonectomy, n = 2; bilobectomy, n = 2) as a consequence of pulmonary complications. Operative survivors had a pulmonary morbidity of 18%. Fourteen of 20 long-term survivors were found to have a satisfactory performance status at follow-up.

CONCLUSIONS: Otherwise young and healthy male nonseminomatous germ cell tumors patients requiring large pulmonary resections after bleomycin-combination chemotherapy appear to be at higher than anticipated risk for pulmonary-related morbidity and mortality. However long-term survivors report an acceptable functional status.

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