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 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.
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-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%.
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 first PC-RPLND.
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AN: Protocol/Project development, Data collection or management, Data analysis, Manuscript writing/editing. MB: Data collection or management, Data analysis, Manuscript writing/editing. AH: Protocol/Project development, Data collection or management. CW: Data collection or management. GA: Protocol/Project development. LS: Protocol/Project development, Data analysis, Manuscript writing/editing. PA: Protocol/Project development, Manuscript writing/editing.
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Nini, A., Boschheidgen, M., Hiester, A. et al. Preoperative clinical and radiographic predictors of major vascular surgery in patients with testicular cancer undergoing post-chemotherapy residual tumor resection (PC-RPLND). World J Urol 40, 349–354 (2022). https://doi.org/10.1007/s00345-021-03870-8
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DOI: https://doi.org/10.1007/s00345-021-03870-8