Surgical removal of retroperitoneal tumors after chemotherapy treated testicular tumors.

In the era of chemotherapy, patients with advanced testicular tumor often presents with residual mass after completion of chemotherapy. Post chemotherapy RPLND is an important part of the multimodality treatment in these patients. According to current guidelines and recommendations, post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is recommended in NSGCT patients with all residual lesions and normalized tumor markers. In seminomas, surgery is considered in patients with residual tumor > 3 cm and a positive positron emission tomography (PET) scan. A conventional bilateral template should be performed for patients undergoing PC-RPLND. However, a modified template can be performed in select patients with low volume disease to reduce the long-term morbidities and peri-operative complications. Laparoscopic PC-RPLND is safe and feasible. The oncological outcome of PC-RPLND is excellent if all tumors are resected. PC-RPLND is a complex surgery and should be done in high volume tertiary centers.