The place of surgery in the treatment of seminomatous testicular tumors.

Accepted indications for surgical intervention in the seminoma patient include, elevated beta HCG of greater than 30 international units, elevated alpha fetoprotein, the presence of mixed germinal tumor and in selected cases of recurrent seminoma and secondary primary seminoma. Questionable indications for surgical intervention include the diagnosis of anaplastic seminoma, any elevation of beta HCG and the presence of bulk disease. Clinical evidence does suggest that the combination of chemotherapy and debulking surgery for high stage seminoma allows for a superior survival of patients in this disease catagory. Its application to patients with low stage disease is largely theoretical, with only rare clinical reports supporting this hypothesis. A study of patients with low stage seminoma, randomizing such patients between retroperitoneal lymph node dissection and definitive radiation therapy appears to be indicated.