Surgical treatment of metastatic germ cell cancer

Among young men between the ages of 15 and 40 years,germ cell cancer is the most common solid tumor[1].The worldwide incidence of germ cell cancer is 70000 cases.Compared to all solid tumors of men,germ cell cancer accounts for 1%of all male tumors.Nevertheless,the mortality of this rare tumor entity is about 13%since 9507 patients died worldwide of germ cell cancer.The improvement in survival of germ cell cancer patients is due to a multimodal treatment of germ cell cancer including cisplatin-based chemotherapy and surgery leading to higher cure-rates even in advanced stages[1],whereas the increasing incidence of germ cell cancers cannot be thoroughly explained.In this article we review the current indications for surgery in metastatic germ cell cancers,highlight the strength and weaknesses of techniques and indications and raise the question how to improve surgical treatment in metastatic germ cell cancer.

D1 versus Modified D2 Gastrectomy for Ca Stomach—A Prospective and Comparative Study

Background: Carcinoma stomach remains a major malignancy and accounts for 10.4% of cancer related deaths globally. Despite improvement in chemo-radiotherapy, surgery remains the primary curative modality with special emphasis on lymphadenectomy. However the extent of lymphadenectomy performed by surgeons all over the world differs. Generally speaking, in Japan and Korea, the standard curative protocol would entail a “D2” lymphadenectomy whereas in the western world it would be considered unnecessary and the standard protocol would entail a standard “D1” lymphadenectomy. Thus prompting a newer surgical therapy of modified D2 in dissection in which pancreas and spleen are preserved. Lymph nodes surrounding stomach are divided into 20 stations and these are classified into three groups depending upon the location of the primary tumour. Aims & Objectives: The aims and objectives are to compare: 1) operative time of modified D2 gastrectomy with that of D1 gastrectomy;2) operative morbidity and mortality of modified D2 gastrectomy with that of D1 gastrectomy;3) the disease recurrence between modified D2 & D1 gastrectomy. Materials & Method: The study entitled D1 versus modified D2 gastrectomy for Ca stomach—a prospective, comparative study was conducted in the Postgraduate Department of General Surgery, Government Medical College, Srinagar as a prospective, comparative study over a period of three years 2012-2014. Patients with resectable gastric cancer were taken as subjects for the study and were divided in 2 groups that were closely matched to avoid any bias. Assessment of both the groups was done in identical fashion as per standard protocol. One group underwent gastrectomy with D1 lymph node dissection whereas the other group underwent gastrectomy with a modified D2 lymph node dissection (spleen and pancreas preservation). The type of lymphadenectomy was decided on randomization (simple random sampling). Results: After comparing the two procedures, it was noted that: 1) modified D2 lymphadenectomy took on an average 2 hours more than D1 gastrectomy;2) operative mortality was same in both the procedures. Operative morbidity was seen more in modified D2 group than D1 group however this difference was statistically insignificant;3) number of recurrence was quite significant in D1 group but no recurrence was seen in modified D2 group. Conclusion: On the basis of the study, we recommend that modified D2 gastrectomy is a better procedure than D1 gastrectomy for patients of carcinoma stomach undergoing curative resection.