Postchemotherapy surgery for germ cell tumors--what have we learned in 35 years?
Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.
Levine Cancer Institute and McKay Department of Urology, Carolinas Healthcare System, Charlotte, North Carolina, USA.
Stephen B
SB
Riggs
Earl F
EF
Burgess
Kris E
KE
Gaston
Caroline A
CA
Merwarth
Derek
D
Raghavan
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery*; D012187:Retroperitoneal Space / Q000473:pathology; D018239:Seminoma / Q000188:drug therapy / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
Germ cell tumor; Nonseminoma; Postchemotherapy retroperitoneal lymph node dissection; Retroperitoneal lymph node dissection; Seminoma; Testicular cancer