Clinical utility of vascular proximity metrics on preoperative CT imaging in pediatric retroperitoneal teratoma.

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.