Post-chemotherapy retroperitoneal lymph node dissection in advanced germ cell tumors

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is considered an important therapeutic and staging modality in advanced germ cell tumors (GCTs). An important step to better define the boundaries of PC-RPLND is to define the site of extra-template disease. Modified template RPLND causes less complications and better quality of life parameters; however, bilateral full template surgery accomplishes improved staging and better oncological outcomes. Recent data shows that minimally invasive PC-RPLND has several limitations, so it is not proven oncologically yet. It's one of the most challenging surgeries in urology practice. PC-RPLND should be performed only in experienced centers since it's not only a difficult surgery associated with major complications but also it often requires implementation of additional major procedures for complete removal of residual masses. PC-RPLND is an integral part of the multidisciplinary management. Residual tumor surgery for advanced stage testicular tumors ends up with viable tumors in about 50% of cases.