The role of surgery in advanced testicular cancer.

Advanced testicular cancer is best treated with combination platinum-based chemotherapy as primary therapy. If there is only moderate tumor bulk at presentation, many patients will achieve a complete remission and have no evidence of disease thereafter. Those with more bulky tumor who obtain a partial remission should then have residual tumor completely resected by surgery. This effectively restages the patient, provides therapeutic benefit to many, and determines the need for additional chemotherapy. If carcinoma is found in the resected specimen, further "salvage" chemotherapy is required. If the resection is grossly complete, even this group can obtain survival in the majority of cases.