Resection of retroperitoneal residual tumor after chemotherapy for testicular cancer indication and surgical techniques.
The standard therapeutic approach to patients with advanced germ cell tumors is a combination of systemic chemotherapy with surgical removal of the residual disease. The indication of residual tumor resection (RTR) has changed during the last 10 years. Surgery is not longer recommended after chemotherapy of pure seminoma and surveillance of the residual tumor is the favored option. In nonseminomatous tumors, surgery after chemotherapy is recommended in most of the cases since large studies have shown that a considerable proportion of patients with complete radiological remission after chemotherapy harbor vital carcinoma or teratoma. Prediction models of necrosis after chemotherapy in order to avoid RTR are not generally accepted since the accuracy of most models is too low. RTR is indicated in patients with elevated markers after two different chemotherapy regimens (including salvage chemotherapy) either to resect teratoma or cystic residual disease or to remove chemorefractory disease. In patients with marker normalisation after chemotherapy and necrotic tissue in frozen section histology, the surgical field may be reduced to the left- or right-sided template, respectively. In these patients, nerve sparing techniques are applicable in order to preserve antegrade ejaculation. However, especially in patients with teratoma, yolk sac or non germ cell tumors after chemotherapy, the surgical removal of the residual tumor should follow the formal ipsilateral template in order to avoid late relapse of chemorefractory disease. RTR is technically demanding and lowest morbidity and best long term outcome is achieved in specialized centers only.
Albers
Peter
P
Department of Urology, Bonn University, Sigmund Freud Strasse 25, D-53105 Bonn, Germany. albers@mailer.meb.uni-bonn.de
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D012186:Retroperitoneal Neoplasms / Q000556:secondary* / Q000601:surgery*; D013514:Surgical Procedures, Operative; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents