The role of surgery in advanced testicular cancer

As from 1976 65 patients with advanced testicular cancer (non-seminomatous) were treated with intensive chemotherapy. In 28 cases chemotherapy induced a complete remission; in six cases the tumor masses did not disappear, with persisting high level of markers. In 31 cases the markers normalized but abnormalities persisted on palpation and/or on X-rays and CT-scans. In these cases operations were performed. Biopsies were taken (11/31) or, if possible, residual lesions were completely excised (20/31) without attempts to do radical retroperitoneal dissections or aggressive or dangerous debulking. Only in a minority of cases (five patients) vital tumor was found; in six cases mature teratoma was found; in all other cases only necrosis or scar tissue was found. The findings in these staging operations indicated the further treatment. Patients with vital tumor continued with intensive chemotherapy. The others received a consolidation course or no further treatment. The actuarial four-year survival rate of these operated re-staged patients exceeds 90%. All three patients with vital tumor, where complete excision was possible, are still alive in complete remission, and one of two patients where vital tumor was only biopsied, is still in complete remission of long duration after continuation of chemotherapy.