title: Excision of retroperitoneal germ cell tumor in children: A distinct surgical challenge.
abstract: OBJECTIVE
  The excision of retroperitoneal germ cell tumor (GCT) is a surgical challenge compounded by the absence of definite surgical guidelines. The aim of this study is to present the surgical difficulties and morbidity associated with resection of these tumors.
  
  
  METHODS
  Fifteen patients (7 males and 8 females) undergoing excision of retroperitoneal GCT between February 2008 and February 2016 were evaluated.
  
  
  RESULTS
  Except for an adolescent, the majority of patients were infants (median age: 4months). The surgical excision entailed extensive vascular dissection in all patients with associated significant blood loss in two, adjacent organ removal in five, and vessel repair in one patient. The resection was complete in all except two patients. Both the patients with incomplete resections had immature teratoma and received postoperative chemotherapy. At a median follow-up of 53months, 13 patients are alive and disease free, one patient is alive with stable disease, and one patient had died owing to respiratory complications. There were no local recurrences in the patients with complete excision.
  
  
  CONCLUSIONS
  Although the outcomes are excellent after surgery, resection of retroperitoneal GCT is a distinct surgical challenge. The surgical difficulties emanate from the need for extensive vascular dissection and risk to adjacent structures.
  
  
  METHODS
  Therapeutic study.
authors.affiliation: Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Bombay, India. Electronic address: sajidshafiques@hotmail.com.
authors.forename: Sajid S
authors.initials: SS
authors.lastname: Qureshi
authors.affiliation: Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Bombay, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Kammar
authors.affiliation: Department of Radiology, Tata Memorial Centre, Bombay, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Kembhavi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000601:surgery*; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Complications; Germ cell tumor; Pediatric; Retroperitoneum; Surgery; Teratoma