Preoperative clinical and radiographic predictors of major vascular surgery in patients with testicular cancer undergoing post-chemotherapy residual tumor resection (PC-RPLND)

Abstract

Purpose To evaluate the probability to correctly predict major vascular surgery (MVS) in patients undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular cancer. Methods From a database of 504 RPLNDs performed in 434 patients (2008–2018), 78 patients submitted to PC-RPLND for non-seminoma germ-cell cancer after cisplatin-based chemotherapy with available preoperative CT scans were identifed. Second PC-PLNDs (Re-Dos), salvage RPLNDs, or RPLNDs for late-relapse were excluded as well as thoraco-abdominal approaches. Preoperative imaging was reviewed by a urologist and a radiologist blinded to operative details. Results Of 78 patients, 16 (20.5%) underwent MVS (caval and/or aortic replacement or reconstruction). On univariable analyses, transversal diameter, sagittal diameter, tumor volume, aorta- and cava-tumor contact angle, poor IGCCCG score, clinical stage III and preoperative positive markers were predictors of MVS (all p values≤0.01). At multivariable analyses aorta- (cut-of 64°) and cava-tumor contact angle (cut-of 98°) and poor IGCCCG score represented the three most important predictors of MVS (all p values≤0.05). The model constructed has a PPV 100%, NPV 87% and an accuracy of 88%. Conclusions Presence of aorta-tumor contact angle≥64°, cava-tumor contact angle≥98° and poor IGCCCG score identify correctly 9 out of 10 patients requiring MVS at the time of frst PC-RPLND.