Excision of retroperitoneal germ cell tumor in children: A distinct surgical challenge

Purpose: The excision of retroperitoneal germ cell tumor (GCT) is a surgical challenge compounded by the absence of definite surgical guidelines. The aim of this study is to present the surgical difficulties and morbidity associated with resection of these tumors. Methods: Fifteen patients (7males and 8 females) undergoing excision of retroperitoneal GCT between February 2008 and February 2016 were evaluated. Results: Except for an adolescent, the majority of patients were infants (median age: 4 months). The surgical excision entailed extensive vascular dissection in all patients with associated significant blood loss in two, adjacent organ removal in five, and vessel repair in one patient. The resection was complete in all except two patients. Both the patients with incomplete resections had immature teratoma and received postoperative chemotherapy. At a median follow-up of 53 months, 13 patients are alive and disease free, one patient is alive with stable disease, and one patient had died owing to respiratory complications. Therewere no local recurrences in the patients with complete excision. Conclusion: Although the outcomes are excellent after surgery, resection of retroperitoneal GCT is a distinct surgical challenge. The surgical difficulties emanate from the need for extensive vascular dissection and risk to adjacent structures. (C) 2017 Elsevier Inc. All rights reserved.