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

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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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Author notes

  1. Alessandro Nini and Matthias Boschheidgen equally contributed.

Authors and Affiliations

  1. Department of Urology and Pediatric Urology, Saarland University Medical Center, Universitätsklinikum des Saarlandes, Saarland University, 66421, Homburg/Saar, Germany

    Alessandro Nini

  2. Division of Experimental Oncology/Unit of Urology, Department of Urology, URI, IRCCS San Raffaele Scientific Hospital, Milan, Italy

    Alessandro Nini

  3. Institute for Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    Matthias Boschheidgen, Gerald Antoch & Lars Schimmöller

  4. Department of Urology, Medical Faculty, University Hospital, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

    Alessandro Nini, Andreas Hiester, Christian Winter & Peter Albers

Authors
  1. Alessandro Nini
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  2. Matthias Boschheidgen
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  3. Andreas Hiester
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  4. Christian Winter
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  5. Gerald Antoch
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  6. Lars Schimmöller
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  7. Peter Albers
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Contributions

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.

Corresponding author

Correspondence to Alessandro Nini.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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The study was carried out following the recommendations of the University of Duesseldorf after internal approval by the University of Duesseldorf Ethical Committee.

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All subjects gave written informed consent in accordance with the Declaration of Helsinki.

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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

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