Growing teratoma syndrome is a rare entity where serum tumour markers normalise, but tumour size increases on imaging while under ongoing chemotherapy. It Requires complex multidisciplinary management where complete surgical resection is the ultimate aim. Adjunctive procedures can occur in 23-100% (vascular reconstruction and nephrectomies), which can subsequently lead to considerable morbidity (18-44%). This contemporary series explores this phenomenon when being done in a tertiary centrewith a multidisciplinary approach.

A single institutional Retrospective review of patients with a diagnosis of GTS was done over the last 5 years.

A total of 13 patients were included. After preoperative rehabilitation, most patients were operated on in CTVS OT with a team of urosurgeon, CTVS surgeons, GI surgeons and thoracic surgeons. All patients had R0 resection except one. Except one all other patients were operated in single sitting. GI surgeon was involved in 2 cases for the resection of liver lesions and peripancreatic lesions, respectively, while a thoracic surgeon was involved for the resection of mediastinal masses. One of the patients required major vascular reconstruction(aortic replacement with , and left-sided nephrectomy was required in only two patient (15.3%). None of the patients had clavin-dindo 3 or above complications. The most common postoperative complication was paralytic ileus (4/13), followed by SSI (2/13), which were managed conservatively. One patient had a malignant transformation of neuroectodermal in origin in final pathology. At the end of a one-year follow-up, two patient had a small recurrence, out of which one is under observation while one patient underwent redo surgery (only fibrosis

For Improved oncologic outcomes : (Multidisciplinary) 1. Early recognition of the paradox 2. Completion of initially stage-stratified numbers of chemotherapy 3. Complete surgical resection of residual masses