Cytoreductive surgery for advanced nonseminomatous germ cell tumors of testis.

Cytoreductive surgery increases the cure rate in selected patients with advanced nonseminomatous germ cell tumor receiving chemotherapy. Complete resection of residual malignancy is a prerequisite for improving long-term disease-free survival after chemotherapy. Complete resection of residual tumor after three to four inductions with an optimal chemotherapy regimen is the current recommendation. Progression of disease on chemotherapy represents a contraindication to cytoreductive surgery. Residual malignant tissue is found in up to one third of patients with clinical evidence of residual disease after chemotherapy and currently constitutes a current indication for further chemotherapy. Incomplete resection of malignant tissue and elevated tumor markers after surgery are poor prognostic signs. Elevated serum tumor marker levels after chemotherapy and prior to surgery represent a relative contra-indication to surgery, and such patients should receive additional chemotherapy.