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Approach to surgery following chemotherapy for advanced testicular germ cell tumors

Graeme S Steele, MBBCh, FCS
Jerome P Richie, MD, FACS
Section Editor
Philip W Kantoff, MD
Deputy Editor
Michael E Ross, MD


Testicular cancers, 95 percent of which are germ cell tumors (GCTs), are one of the most curable solid neoplasms because of treatment advances that began in the mid-1970s. Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 to 34, and the five-year survival rate was 64 percent [1]. Over the past 30 years, testis cancer incidence has increased 50 percent while mortality has declined 60 percent [2]. Currently, there are approximately 400 deaths per year in the United States, and the five-year survival rate is over 95 percent [3].

Cisplatin-based regimens can cure patients with advanced GCTs, even in the context of widespread visceral metastases, highly elevated serum tumor markers, or other adverse prognostic features. Following chemotherapy, the role of surgery depends on the histological type; for men with nonseminomatous germ cell tumors (NSGCTs), a multimodality approach of chemotherapy followed by resection of all residual masses when technically feasible is the standard of care. In contrast, advanced stage seminomas are often managed with chemotherapy alone; the resection (or biopsies) of residual masses are only performed under certain specific circumstances. (See "Initial risk-stratified treatment for advanced testicular germ cell tumors".)

Men with rising tumor markers at the end of treatment have chemorefractory disease. In general, these patients should be treated with second-line systemic chemotherapy, although surgery may represent the patient's best chance of cure in selected cases [4]. (See "Diagnosis and treatment of relapsed and refractory testicular germ cell tumors".)

This topic will review the role of surgery after chemotherapy in men with advanced disease. A general overview of the treatment of testicular cancer and the role of retroperitoneal lymph node dissection for early stage GCT (primarily in relation to men with NSGCT) are presented separately. (See "Overview of the treatment of testicular germ cell tumors" and "Retroperitoneal lymph node dissection for early stage nonseminomatous testicular germ cell tumors".)


Following chemotherapy or radiation therapy (RT) for advanced germ cell tumor (GCT), all patients should undergo imaging, utilizing either high-resolution computed tomography (CT) or magnetic resonance imaging (MRI). The imaging characteristics of these masses differ by whether the primary tumor is a seminoma or a nonseminomatous germ cell tumor (NSGCT).

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Literature review current through: Oct 2017. | This topic last updated: Jan 17, 2017.
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