Postchemotherapy surgery for germ cell tumors of the testis.

Overview

PURPOSE OF REVIEW: To summarize the surgical management of metastatic germ cell tumors of the testis, highlighting the indications for surgery and controversies surrounding the integration of surgery. RECENT FINDINGS: The multidisciplinary approach to the management of germ cell tumors of the testis has resulted in survival rates of greater than 90% overall. However, controversies exist regarding the surgical management of patients who achieve a complete radiographic response following chemotherapy as well as the appropriate retroperitoneal templates to use in the postchemotherapy setting. Recent data have demonstrated that despite a complete radiographic response, approximately 30% of patients will harbor either viable cancer or teratoma in the retroperitoneum. With advances in nerve-sparing techniques and the probability of disease extending beyond the anatomic boundaries of modified templates, a bilateral nerve-sparing retroperitoneal lymph node dissection is the treatment of choice for patients with metastatic nonseminoma, initially treated with chemotherapy. SUMMARY: Postchemotherapy surgical resection of all sites of residual disease remains a critical component to the multidisciplinary management of metastatic testicular cancer.