- Journal
- BULLETIN DU CANCER
- Année
- 2020
- Volume
- 107
- Numéro
- 2
- Pages
- 215-223
- Mois
- FEB
- DOI
- 10.1016/j.bulcan.2019.10.010
Abstract
A residual mass (RM) is an abnormal image with a transverse axis of more than 1 cm trans that remains visible on the CT scan performed after chemotherapy for metastatic germ cell tumors. Their management depends on the histology of the initial tumor. In the case of a non-seminomatous germ cell tumor, all residual lesions must be resected if the tumor markers are negative. The surgery usually begins with a retroperitoneal lymphadenectomy. This lymphodenectomy is a programed regional surgery and not the only resection of visible masses. All RM must be resected, regardless of their location, and may require successive actions. In order to limit its morbidity, modifications on the extent of the lymphodenectomy and the use of minimally invasive approaches are proposed by some center. When the initial tumor is a pure seminoma the attitude is different: the decoy of the masses in post chemotherapy is often postponed. If lesions less than 3 cm con be monitored, the others benefit from 18FDG PET at the end of chemotherapy: a positive attachment to PET is suspected of the presence of residual active tissue. The surgery of these RM is curative. If its extent is precise in the case of non-seminomotous tumor, it is more controversial in the case of seminoma. In the case of residual markers, surgery has a place in very specific situations.