Nini A, Boschheidgen M, Hiester A, et al. - This study unveiled factors (presence of aorta-tumor contact angle ≥ 64°, cava-tumor contact angle ≥ 98° and poor IGCCCG score) that allowed to identify correctly 9 out of 10 patients needing major vascular surgery (MVS) at the time of first post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular cancer.

• This study involved 78 patients submitted to PC-RPLND for non-seminoma germ-cell cancer following cisplatin-based chemotherapy with available preoperative CT scans; 20.5% received MVS (caval and/or aortic replacement or reconstruction).

• Following predictors of MVS were revealed in univariable analyses: transversal diameter, sagittal diameter, tumor volume, aorta- and cava-tumor contact angle, poor IGCCCG score, clinical stage III and preoperative positive markers.

• The three most important predictors of MVS, in multivariable analyses, were: aorta- (cut-off 64°) and cava-tumor contact angle (cut-off 98°) and poor IGCCCG score.

• A PPV 100%, NPV 87% and an accuracy of 88% was achieved with the model constructed.