title: Surgery in metastatic testicular cancer.
abstract: Surgery in advanced testicular tumors is an integral part of the multimodality treatment. However, the indications for surgery in testis cancer have changed over the last 10 years. Patients with advanced seminoma only rarely will need surgery after chemotherapy whereas patients with advanced non-seminoma need to undergo the resection of residual disease in most of the cases. Surgery in metastatic disease may even be beneficial for patients with recurrent tumors, patients with persisting marker elevations during chemotherapy, or patients with late relapse of the disease. In view of late relapse, the extent and completeness of the primary resection is an important issue and, therefore, surgery should be performed in specialized centers. Most of the procedures are technically demanding and, therefore, individualized perioperative precautions are necessary to reduce morbidity of surgery. Nevertheless, in individual cases nerve-sparing techniques and laparoscopic approaches may be applicable to reduce surgery-related morbidity. This review will update the current indications and recommendations for post-chemotherapy surgery in advanced testis cancer.
authors.affiliation: Department of Urology, Bonn University, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. peter.albers@ukb.uni-bonn.de
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.forename: Diethild
authors.initials: D
authors.lastname: Melchior
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
mesh_terms: D024221:Antineoplastic Protocols; D001011:Aorta / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D007414:Intestinal Neoplasms / Q000556:secondary / Q000601:surgery; D007680:Kidney Neoplasms / Q000556:secondary / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary* / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D018239:Seminoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D013131:Spine / Q000601:surgery; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000556:secondary / Q000601:surgery; D019043:Vascular Neoplasms / Q000556:secondary / Q000601:surgery; D014684:Venae Cavae / Q000601:surgery