Postchemotherapy Retroperitoneal Residual Tumor Resection for Minimal Residual Disease

ContextResidual tumor resection (RTR) after chemotherapy in patients with advanced germ cell tumors is an important part of multimodal treatment. Patients with minimal residual disease present a controversial subgroup in terms of recommendations for postchemotherapy surgery. This paper critically reviews the necessity or expendability of postchemotherapy RTR in patients with minimal residual disease (<1 and 1–2 cm).ObjectiveTo describe and compare reasons for necessity or expendability of postchemotherapy RTR.Evidence acquisitionThis paper is based on the symposium “Debate: NSGCT post-chemotherapy RPLND: Everybody or nobody?” by Peter Albers at the 8th Meeting of EAU Section of Oncological Urology in January 2011 in London (GB).Evidence synthesisPostchemotherapy retroperitoneal surgical resection is necessary when tumor markers have normalized and residual radiographic abnormalities are present. The need for a postchemotherapy retroperitoneal lymph node dissection in the face of a normal computed tomography scan or in patients with minimal residual disease <1 cm is controversial. No predictive model and no imaging evaluation predict necrosis at retroperitoneal pathology with sufficient accuracy following induction chemotherapy. The rate of vital cancer after chemotherapy is about 10% in residual tumors <1 cm and 20% in residual tumors <2 cm. Relapse of chemorefractory disease can be fatal: The cure rate of late relapsing patients is only about 60%.ConclusionsEspecially in patients with intermediate and poor prognosis, observation is not recommended even if only minimal residual disease is present after chemotherapy.