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<p>Postchemotherapeutic residual tumor resection (PC-RTR) is an integral part of the multimodal therapy of metastatic testicular germ cell tumors and ensures a&#xa0;high curation rate with the correct indication, adequate implementation, and sufficient surgical expertise. Histopathologically, vital carcinoma is found in 10–15%, teratoma and/or malignant somatic transformation in 30–50%, and scar/necrosis in 50% of patients. While the indication for PC-RTR is cautious in metastatic seminomas, in non-seminomas it is usually performed in residual tumors &gt;1 cm in diameter. Only in patients with an initially unfavorable prognosis should PC-RTR always be performed if visible residuals are present in conventional imaging. Depending on the extent of metastases before and after induction chemotherapy, PC-RTR is performed unilaterally to protect the nerves or bilaterally radically. The primary goal of the operation is complete resection of all residuals, regardless of anatomical position and extent, so that in about 25% of patients, resection of neighboring organs is to be expected. Hepatic residual tumors can certainly be observed, while pulmonary residuals must always be resected unilaterally first. In the case of bipulmonary involvement, contralateral resection is only necessary if teratoma or carcinoma is detected unilaterally due to the high concordance of the histology of both lungs. As it is a&#xa0;complex operation with a&#xa0;high curative value, PC-RTR should only be performed in centers with sufficient experience in specialized testicular tumor surgery.</p>

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Stellenwert der Residualtumorresektion beim testikulären Keimzelltumor

  • 期刊论文

  • 发表日期：

    2025年11月28日

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  • Axel Heidenreich,
  • Olivia Steenbock,
  • Julian Heidenreich,
  • David Pfister

摘要

Postchemotherapeutic residual tumor resection (PC-RTR) is an integral part of the multimodal therapy of metastatic testicular germ cell tumors and ensures a high curation rate with the correct indication, adequate implementation, and sufficient surgical expertise. Histopathologically, vital carcinoma is found in 10–15%, teratoma and/or malignant somatic transformation in 30–50%, and scar/necrosis in 50% of patients. While the indication for PC-RTR is cautious in metastatic seminomas, in non-seminomas it is usually performed in residual tumors >1 cm in diameter. Only in patients with an initially unfavorable prognosis should PC-RTR always be performed if visible residuals are present in conventional imaging. Depending on the extent of metastases before and after induction chemotherapy, PC-RTR is performed unilaterally to protect the nerves or bilaterally radically. The primary goal of the operation is complete resection of all residuals, regardless of anatomical position and extent, so that in about 25% of patients, resection of neighboring organs is to be expected. Hepatic residual tumors can certainly be observed, while pulmonary residuals must always be resected unilaterally first. In the case of bipulmonary involvement, contralateral resection is only necessary if teratoma or carcinoma is detected unilaterally due to the high concordance of the histology of both lungs. As it is a complex operation with a high curative value, PC-RTR should only be performed in centers with sufficient experience in specialized testicular tumor surgery.