Over the past 2 to 3 decades, the role of postchemotherapy surgery for advanced GCT has undergone a remarkable transformation. With the introduction of cisplatin-based chemotherapy and refinements in imaging technology, postchemotherapy surgery has become an integral component of the multimodality approach to treating advanced GCT. This combined approach has resulted in cure rates of approximately 80% in patients who have advanced GCT. We believe that postchemotherapy surgery is indicated for patients who have residual radiographic disease and normalized serum tumor markers. The benefit of postchemotherapy surgery both within and outside of the retroperitoneum depends on the histology of the resected specimen. Unfortunately, no set of variables can accurately predict necrosis and thus obviate the need for surgery. Multiple studies have demonstrated that histology in the RPLND specimen does not correlate well enough with other sites of residual disease, such as the mediastinum and lungs, to preclude their resection. Emerging evidence suggests that at least intermediate-risk patients benefit by receiving additional chemotherapy. The complex integration of multiple surgical specialists, aggressive evaluation, and proactive resection of persistent non-retroperitoneal masses is imperative in the effective management of male GCT.

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