Surgical resection of residual tumor masses after chemotherapy in testicular cancer

Surgical resection of residual retroperitoneal lymph nodal masses or residual visceral metastases after chemotherapy is an important part of the oncological approach in patients with advanced testicular cancer. The aim is the complete and radical surgical excision of the persistent disease that may contain mature teratoma in 30–40%, and active cancer cells in 10–20% of the patients. Mature teratoma should be removed because of its predisposition for local growth, malignant transformation and possible recurrence. Furthermore, persistent neoplastic masses with active cancer cells represent a form of disease with endogenous or exogenous chemo-resistance, predisposing to neoplastic relapse if not removed, despite any second-line chemotherapy. In patients with seminoma tumour, the retroperitoneal dissection is indicated for tumours > 3cm, as well as for those 90%. Even after “salvage” chemotherapy, aggressive surgical treatment achieves cure in 55% of patients. In highly selected patients, surgical treatment of liver metastases is appropriate and is followed by a five-year survival rate >70%. In all cases, treating these recurrences requires an experienced surgical team and a multi-oncological approach.