Role of surgical resection for refractory germ cell tumors

PurposeThis article aims to critically review the current recommendations with regard to the role of surgery following salvage chemotherapy, growing teratoma syndrome, late relapse, as well as malignant transformation.MethodsAll the literature published in English and available on Pubmed pertaining to refractory germ cell tumors was reviewed and the relevant articles, as well as our own institutional experience were included in this review.ResultsThere is universal agreement that patients with non-seminoma who have residual tumor measuring greater than one centimeter should undergo post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for resection of potential teratoma or viable germ cell tumor. The role of surgical resection is less clear in patients who are deemed to have germ cell tumors refractory to chemotherapy. Patients with residual masses following second line therapy, those with growing teratoma, late relapse, and malignant transformation should all be considered for upfront surgical resection. Compared with the typical PC-RPLND, these operations are generally more complex, with a higher proportion requiring adjunctive procedures; and should be performed in experienced, tertiary referral centers.ConclusionPatients who have complete resection of disease are sill curable and patients with chemorefractory disease should have evaluation by an expert surgeon.