Patients with primary extragonadal, retroperitoneal germ cell tumors usually have very advanced disease and present uncharacteristic signs and symptoms. We report a case of a patient with large retroperitoneal choriocarcinoma. After four initial cycles of chemotherapy, the patient underwent debulking surgery including angiorrhaphy and-plasty. This therapeutic management was justified, as it revealed active residual tumor. Furthermore, a large tumor mass was removed with vascular and ureteric decompression. As a result of this treatment, adjuvant chemotherapy was more effective. In conclusion, despite possible complications, we recommend this regimen in young patients.