Retroperitoneal lymph node dissection for growing teratoma syndrome in testicular cancer: a systematic review of surgical outcomes

Growing Teratoma Syndrome (GTS) is a rare entity occurring in patients with non-seminomatous germ cell tumours (NSGCT) following chemotherapy. GTS is resistant to chemotherapy and radiotherapy, making retroperitoneal lymph node dissection (RPLND) the mainstay of treatment. This review aims to synthesize evidence on the surgical management and oncological outcomes of retroperitoneal GTS. A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251233173). PubMed and Embase were searched from inception to November 2025. Risk of bias was assessed using the ROBINS-I tool. Fifteen studies comprising 156 patients with NSGCT-associated retroperitoneal GTS treated with RPLND were included. The reported incidence ranged from 2.8% to 7.6%. Median patient age across studies was 16–38 years. Mixed NSGCT was present in 73–100% of orchidectomy specimens, with a teratoma component identified in 40–100%. The interval to RPLND ranged from 2 to 30 months and median operative time ranged from 160 to 432 min, and estimated blood loss from 225 to 2500 mL. Adjunctive procedures were required in 10–100% of patients, and postoperative complications occurred in 12.5–44%, with Clavien-Dindo ≥ III complications in 12.5–25%. Median length of hospital stay ranged from 5 to 15 days. Disease-free survival varied between 41.7% and 100%, and overall survival between 73.7% and 100% with follow-up ranging from 8 to 103 months. RPLND is a complex procedure with effective oncological outcomes for GTS. Multicentric registries are needed for generating high-quality standardised data.