Surgery of retroperitoneal residual mass

Objective: 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.

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

Results: 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.

Conclusions: 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.