Non-seminomatous germ cell tumors (NSGCTs) of the testis are highly curable, yet a subset of patients experiences persistent elevation of serum tumor markers (STMs) despite optimal chemotherapy. Desperation retroperitoneal lymph node dissection (RPLND) is considered in such cases, especially when disease progresses despite multiple lines of systemic therapy.

A 28-year-old male with NSGCT underwent right high inguinal orchidectomy in August 2020, followed by 4 cycles of BEP chemotherapy. After a 3.5-year remission, he developed rising AFP levels (up to 5910 ng/mL) and radiological progression of retroperitoneal lymph nodes and lung nodules. He received TIP and Gem-Ox chemotherapy without sustained response.

The patient underwent desperation RPLND. Surgery was uneventful, and he was discharged on POD 4. Histopathology showed mature teratoma and yolk sac tumor components in paracaval and para-aortic lymph nodes. Postoperative tumor markers declined, indicating treatment response

Desperation RPLND can offer durable disease control in selected patients with chemo-refractory NSGCT. Careful patient selection, surgical expertise, and a multidisciplinary approach are essential for optimal outcomes in this high-risk setting.