Second-look lymphadenectomy in the treatment of germ cell testis tumors.

A retroperitoneal relapse of germ cell tumors following retroperitoneal lymphadenectomy (RLA) demands a new treatment regimen aiming towards cure. The combination of primary chemotherapy and subsequent second-look operation has proved successful. The results reviewed are concerned with a revision operation (n = 22) usually following cytostasis (n = 15). In 6 cases, a nonoperable situs was discovered after false-positive findings on examination. In 7 other patients the proposed radical removal of the relapse tumor was successful. Nine times the operation only had a palliative character. After histological examination of the dissectate, we found highly malignant tumor fragments in 9 cases; five times we resected 'mature teratomas'; two times we found only necrotizing or fibrotically degenerated malignoma remnants. The result of the pathological-histological examination has a decisive meaning for the younger patient.