4528 Background: Cisplatin-based chemotherapy (CTx) followed by surgical extirpation of residual disease represents the usual sequence of curative therapy for metastatic non-seminomatous germ cell cancer of testicular origin (NSGCT). Occasionally residual disease is chemorefractory in the form of either persistent NSGCT or degeneration into non-germ cell cancer (NGCC). This retrospective review evaluated patients (pts) undergoing “salvage” surgery to remove chemorefractory cancer metastatic to the thorax. Methods: From 1981–2001, 438 pts with NSGCT had surgery to remove residual intrathoracic disease after CTx at Indiana University Hospital. A subset of 134 pts who underwent 186 thoracic surgical procedures to remove chemorefractory cancer is the basis of this review. Eighty-one (60.4%) pts underwent second line CTx prior to surgery and 72 (53.7%) had elevated serum tumor markers at the time of surgery. The mean age was 27 yrs. Eighty-four pts had removal of pulmonary metastases, 74 mediastinal metastases, and 26 had removal of both pulmonary and mediastinal metastases. Surgical pathology demonstrated 84 pts with persistent NSGCT, 38 with NGCC, and 12 had both malignant pathologic categories. Sixty-eight pts with persistent NSGCT received CTx after surgery. Results: There were 4 (2.1%) operative deaths. The median survival was 67 months in operative survivors with 55 (41%) pts alive and well after a mean follow-up of 49 months. Twenty-seven variables were analyzed using Cox regression. Of these, older age (p<0.01) and pulmonary (vs. mediastinal) metastases (p=0.01) were significantly predictive of poorer long-term survival. Log rank analysis additionally identified preoperative BHCG≥1,000ng/ml (p<0.04) and ≥ 4 metastases (p<0.01) as negative predictors for survival. Conclusions: Aggressive “salvage” surgical therapy to remove chemorefractory cancer metastatic to the thorax can result in long-term survival. We have identified variables which appear to influence survival for this subset of NSGCT pts. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration GlaxoSmithKline GlaxoSmithKline