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Cervical metastasis of germ cell tumors: Evaluation, management, complications, and outcomes

Authors

  • Saral Mehra MD, MBA,

    Corresponding author
    1. Department of Otorhinolaryngology–Head and Neck Surgery, New York Presbyterian Hospital–Weill Cornell Medical College, New York, New York
    2. Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
    • Department of Otorhinolaryngology–Head and Neck Surgery, Weill Cornell Medical College, 1320 York Avenue, 5th Floor, New York, NY 10065
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  • Jeffrey Liu MD,

    1. Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
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  • Amit Gupta MD,

    1. Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
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  • Joel Sheinfeld MD,

    1. Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
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  • Dennis Kraus MD

    Corresponding author
    1. Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
    • Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Head and neck surgeons can be involved in the management of germ cell tumor (GCT) metastatic to the neck from initial diagnosis through postchemotherapy management of residual neck masses. This article reports on 34 consecutive patients with GCT metastatic to the neck.

Study Design:

Retrospective chart review.

Methods:

A single-institution retrospective chart review of 34 consecutive patients with GCT metastatic to the neck who underwent postchemotherapy neck surgery between 1991 and 2009 was performed.

Results:

Seventy-four percent of patients had a neck mass at initial diagnosis, with 50% of patients having a neck mass as the presenting symptom leading to a diagnosis of GCT. Of the 37 neck procedures, positive nodes were found in 22. No significant relationship between preoperative tumor markers and neck pathology (P = .35) was identified. No patients had neck recurrence. No patients had permanent nerve injury or chyle leak. As a secondary end point, survival analysis related to cervical pathology showed that viable tumor in the neck predicted disease-specific survival (P = .01). Five- and 10-year disease-specific survival was 82.3% (median, 52-month follow-up).

Conclusions:

Operative management for patients with metastatic GCT to the neck can achieve long-term durable cervical control with limited complications.

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