Postchemotherapy Resection of Residual Mass in Nonseminomatous Germ Cell Tumor

• Published in: Urologic clinics of North America Vol. 46; no. 3; pp. 389 - 398
• Main Authors: Ghodoussipour, Saum, MD, Daneshmand, Siamak, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2019
• Subjects: Biomarkers, Tumor - analysis; Disease-Free Survival; Germ cell tumor; Humans; Laparoscopy - methods; Lymph Node Excision; Lymphatic Metastasis - pathology; Male; Neoplasm, Residual - drug therapy; Neoplasm, Residual - pathology; Neoplasm, Residual - surgery; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - surgery; Nonseminomatous; Retroperitoneal lymph node dissection; Robotic Surgical Procedures; Salvage Therapy; Testicular cancer; Testicular Neoplasms - drug therapy; Testicular Neoplasms - surgery; Urology; Germ cell tumor; Retroperitoneal lymph node dissection; Nonseminomatous; Testicular cancer
• ISSN: 0094-0143; 1558-318X
• DOI: 10.1016/j.ucl.2019.04.004

The introduction of cisplatin-based chemotherapy has revolutionized the care of patients with disseminated testicular germ cell tumors. Although a majority are cured with chemotherapy alone, surgical resection continues to play a role because one-third will have residual mass after chemotherapy. In this article, we review the current indications for postchemotherapy resection in nonseminomatous germ cell tumors, including masses greater than 1 cm, resection after salvage chemotherapy, with elevated markers, after late relapse, and for growing teratoma syndrome. We also highlight technical considerations of this often-challenging surgery, including the need for adjunctive procedures, extraretroperitoneal resections, and modern techniques to minimize morbidity.