title: Surgical controversies in the management of post-chemotherapy nonretroperitoneal residual disease in metastatic nonseminomatous germ cell tumors.
abstract: Following the advent of platinum-based chemotherapy, Surgery, excepting orchidectomy, has become an adjunct treatment in the management of metastatic non-seminomatous germ cell tumors (NSGCT). Role of surgery comes into play in metastatic NSGCT when residual disease persists following standard chemotherapy. Surgical excision of all post chemotherapy residual disease at all places, whenever surgically feasible with acceptable morbidity and mortality, should be undertaken. As histopathological examination of the excised postchemotherapy residue shows only necrosis and fibrosis in significant number of patients; surgical exercise in this group of patients seems futile and unwarranted retrospectively. This issue becomes more contentious when surgeons are confronted with multiple nonretroperitoneal post chemotherapy residues. This article aims to deal with the management of postchemotherapy nonretroperitoneal residues in metastatic NSGCT.
authors.affiliation: Department of Surgical Oncology, Dr BRA Institute Research Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Durgatosh
authors.initials: D
authors.lastname: Pandey
authors.affiliation: Department of Surgical Oncology, Dr BRA Institute Research Cancer Hospital, All India Institute of Medical Sciences, Delhi, India; Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Garg
authors.affiliation: Department of Surgical Oncology, Dr BRA Institute Research Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Mukur Dipi
authors.initials: MD
authors.lastname: Ray
authors.affiliation: Department of Surgical Oncology, Dr BRA Institute Research Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Mishra
keywords: Germ cell tumors; metastasis; postchemotherapy; surgery