Post-chemotherapy resection of residual tumors in advanced testicular germ cell tumors


Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) represents an integral part of the multimodality management of patients with advanced testicular germ cell tumours. In advanced seminomas PC-RPLND is only indi­cated in the scenario of a residual mass of > 3 cm which demonstrates radionuclide uptake in a FDG-PET/CT and which has been proven by biopsy to harbour vital cancer. The risk of an increased frequency of perioperative complications and a higher morbidity has not been proven in recent studies. In non-seminomas, patients with a residual mass < 1 cm can be followed by active surveillance if they showed a good or intermediate prognosis at start of chemotherapy. In all other cases PC-RPLND is mandatory. According to the Heidenreich criteria, a modified template is sufficient if the residual mass is located in the primary landing zone of the tumour-bearing testicle. In all other cases a full bilateral template resection is mandatory. Depending on the size and the location of the masses, up to 25% of the patients require adjunctive surgery of adjacent vascular, urologic or intestinal organs which needs to be anticipated preoperatively. The risk of significant morbidity and treatment-related death is signif­icantly increased if this surgery is not performed in tertiary referral centres.
Keywords: testicular germ cell tumors, seminoma, non-seminomatous germ cell tumor, post-chemotherapy surgery of residual tumor

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