Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer

To evaluate whether specific clinical or radiographic factors predict inferior vena cava (IVC) or abdominal aortic (AA) resection or reconstruction (RoR) at the time of post-chemotherapy retroperitoneal lymph node dissection (RPLND) for germ cell tumors of the testicle.

277 patients undergoing post-chemotherapy RPLND at two institutions between 2005-2015 were identified. Preoperative imaging was reviewed with radiologists blinded to operative details. Univariable and multivariable logistic regression were performed, and a model created to predict the need for great vessel RoR using radiographic and clinical factors.

Of 97 patients with preoperative imaging and clinical data available, 16 (17%) underwent RoR at RPLND. On univariable analysis dominant mass size, degree of circumferential vessel involvement, and vessel deformity were associated with RoR (all p<0.05). No patients with clinical stage IIA or IIB disease at diagnosis required RoR. In the multivariable model, mass involvement of the IVC > 135° (OR 65.5, 7.8-548, p<0.01) and involvement of the AA > 330° (OR 29.0, 3.44-245, p<0.01) were predictive for RoR. These thresholds yielded a PPV of 48% and 50% and a NPV of 92% and 97% for IVC and AA RoR, respectively.

Degree of circumferential involvement of the great vessels is an independent predictor for resection or reconstruction of the IVC or AA at post-chemotherapy RPLND. Patients at high risk of great vessel reconstruction should be informed accordingly and have the proper teams available for complex vascular reconstruction.

Urology. 2018 Sep 01 [Epub ahead of print]

Scott C Johnson, Zachary L Smith, Charles Nottingham, Zeyad R Schwen, Stephen Thomas, Elliot Fishman, Nam Ju Lee, Philip M Pierorazio, Scott E Eggener

The University of Chicago, Department of Surgery, Section of Urology. Chicago, Illinois. Electronic address: ., The University of Chicago, Department of Surgery, Section of Urology. Chicago, Illinois., James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions. Baltimore, Maryland.