[Surgery of retroperitoneal residual mass]

Surgical treatment of the residual retroperitoneal mass is indicated in 30% of germ cell testicular tumors with lymph node involvement after chemotherapy. This approach is reviewed in the present article.

We reviewed the literature on the surgical treatment of the residual retroperitoneal mass.

CT is reported to be the most sensitive in detecting the nodes, but no diagnostic method can predict the histological characteristics. Surgery of the residual tumor mass demonstrated tumor in 20% of the cases and necrosis (40%) or teratoma (40%) in the rest of the cases. Patients with active tumor benefit from a second course of chemotherapy, which achieves a cancer-specific survival of 63%. If surgery is incomplete, the second course of chemotherapy only achieves 25% remission. Non-responders to the second course of chemotherapy require another surgical procedure, which only achieves 30% remission. Teratoma is chemotherapy-resistant, therefore complete resection is required, which achieves a survival of 94%. Patients with necrosis have 14% extraperitoneal recurrence. Surgical treatment of the residual retroperitoneal mass has a 21% complication rate. Ejaculation is preserved in 76% of the patients by sympathetic nerve-sparing techniques which does not affect survival.

Surgical treatment of the residual retroperitoneal mass is necessary in patients with recurrence post-chemotherapy. It selects the patients with active cancer that require a second course of chemotherapy and permits cure in patients with teratoma.