To evaluate the probability to correctly predict major vascular surgery (MVS) in patients undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular cancer.
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 identified. 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.
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-off 64°) and cava-tumor contact angle (cut-off 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%.
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 first PC-RPLND.
World journal of urology. 2021 Nov 03 [Epub ahead of print]
Alessandro Nini, Matthias Boschheidgen, Andreas Hiester, Christian Winter, Gerald Antoch, Lars Schimmöller, Peter Albers
Department of Urology and Pediatric Urology, Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, 66421, Homburg/Saar, Germany. ., Institute for Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany., Department of Urology, Medical Faculty, University Hospital, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.