Postchemotherapy surgery or residual masses

Where residual masses are present after chemotherapy for metastatic testicular teratoma, surgery should be performed to resect these. The majority of these will be in the retroperitoneum, and extensive and difficult surgery is often necessary for a complete resection. The residual masses may contain differentiated teratoma, fibrosis, or indeed viable tumour, and further chemotherapy may be indicated. Surgery should usually only be undertaken when markers have normalized.

Residual pulmonary masses should also be resected where possible. The problem of surgical technique and anaesthetic risk, particularly as most patients will have been exposed to Bleomycin, again demand that patients are seen and operated on in a centre experienced in this surgery.

Following primary management of metastatic disease, fairly intensive follow-up is necessary as in those patients who relapse, salvage therapy can be effective in about 25% of cases.

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