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.