INTRODUCTION AND OBJECTIVES: The role of surgery for cisplatin-refractory or relapsed germ cell tumors (GCT) following salvage chemotherapy continues to evolve. We report our institutional experience with surgical management of patients following TIP or TICE salvage chemotherapy. METHODS: Data was reviewed on a heterogeneous group of 181 cisplatin-refractory or relapsed patients who received TIP or TICE salvage chemotherapy between 1994 and 2011 at MSKCC. We report clinicopathologic and outcomes data on 131 patients who underwent subsequent surgical management. Predictors of non-teratomatous viable GCT and disease-specific survival (DSS) were analyzed. Median follow-up was 7.3 years. RESULTS: 10-year DSS for this cohort was 73% (95% CI, 64%80%). Of the 112 patients who underwent post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND), 56 (50%) were found to have fibrosis, 30 (27%) had non-teratomatous residual viable disease and 26 (23%) had teratoma only on final pathology. On univariate analysis the risk of finding viable, non-teratomatous residual disease was decreased by (OR < 1): TIP or TICE as salvage regimen vs other regimens (OR 0.1, 95% CI, 0.03-0.43; p< 0.005), surgery within three months of salvage chemotherapy (OR 0.26, 95% CI, 0.08-0.79; p1⁄40.017) and lower clinical stage at diagnosis (stage < IIC vs III, OR 0.37, 95% CI, 0.15-0.90, p1⁄40.028). CONCLUSIONS: Our data suggests that patients with cisplatinrefractory or relapsed GCT who received TIP or TICE as salvage chemotherapy regimen have lower risk of finding non-teratomatous viable disease at resection compared to patients who received other regimens. Surgical resection of all residual disease following salvage chemotherapy should be performed whenever feasible.