Role of Extraretroperitoneal Surgery in Patients with Metastatic Germ Cell Tumors

Surgery remains an integral component of treating metastatic testicular germ cell tumors outside the retroperitoneum. Defining the role of surgery in extraretroperitoneal (ERP) disease can be challenging because metastases can vary in terms their volume, pattern, timing, and responsiveness to systemic therapy. Some of the philosophies on treating ERP disease have come from robust data on outcomes following postchemotherapy retroperitoneal lymph node dissection. The remaining knowledge is gained from retrospective series of different ERP sites from institutions with expertise in treating testis cancer. This article describes how ERP surgery should be integrated into a multidisciplinary treatment plan.