Clinical utility of vascular proximity metrics on preoperative CT imaging in pediatric retroperitoneal teratoma
Masahiro Fukuhara1, Naonori Kawakubo2, Amane Kamouchi1
1Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Purpose:
We identified quantitative cutoff values for CT-based vascular proximity metrics and evaluated their associations with intraoperative complications and extent of resection.
Methods:
We reviewed the records of 20 children who underwent retroperitoneal teratoma resection between 2005 and 2025. Using contrast-enhanced CT, we measured tumor-vessel contact length, counted the number of contacted major vessels, and assigned a vascular deformation score from 0 to 2.
Results:
Intraoperative complications occurred in seven patients (35%). The contacted vessel count was significantly higher in patients with complications (p = 0.015), and contact length showed a similar trend (p = 0.056). Receiver operating characteristic analysis demonstrated good discrimination for contacted vessel count (AUC 0.838; cutoff 3) and contact length (AUC 0.769; cutoff 58.8 mm). Complication rates were highest when the contacted vessel count was ≥ 3 and contact length was ≥ 60 mm. Complete resection was achieved in 15 patients (75%), and subtotal resection was associated with a higher vascular deformation score (p = 0.029).
Conclusion:
Preoperative CT-based vascular proximity assessment helped estimate surgical difficulty in pediatric retroperitoneal teratoma. A contacted vessel count ≥ 3 and contact length ≥ 60 mm indicated higher complication risk, whereas a higher vascular deformation score was associated with subtotal resection.