Postchemotherapy surgery for germ cell tumors of the testis

Purpose of review To summarize the surgical management of metastatic germ cell tumors of the testis, highlighting the indications for surgery and controversies surrounding the integration of surgery. Recent findings The multidisciplinary approach to the management of germ cell tumors of the testis has resulted in survival rates of greater than 90% overall. However, controversies exist regarding the surgical management of patients who achieve a complete radiographic response following chemotherapy as well as the appropriate retroperitoneal templates to use in the postchemotherapy setting. Recent data have demonstrated that despite a complete radiographic response, approximately 30% of patients will harbor either viable cancer or teratoma in the retroperitoneum. With advances in nerve-sparing techniques and the probability of disease extending beyond the anatomic boundaries of modified templates, a bilateral nerve-sparing retroperitoneal lymph node dissection is the treatment of choice for patients with metastatic nonseminoma, initially treated with chemotherapy. Summary Postchemotherapy surgical resection of all sites of residual disease remains a critical component to the multidisciplinary management of metastatic testicular cancer.