Abstract
Background
The concept of complete mesocolic excision (CME) and central vascular ligation (CVL)
in right colonic resections appears to improve the oncological outcomes. The highest
rate of complications reported in the literature in patients undergoing CME is related
to difficult surgical manuevers and intraoperative bleeding due to the central vascular
dissection.
Methods
We used preoperative findings obtained with the CT angiography, multiplanar reformation
(MPR), maximum intesity projection (MIP) and 3D volume rendering (VR) technique to
verify if this preoperative radiological assessment had significant benefits regarding
the difficulty of dissection of the embryological planes, the identification of vascular
structures and central lymph nodes with reduction in mean operative time, intraoperative
complications and better short-term outcomes versus standard contrast enhanced CT
scan. We also have administered a questionnaire to investigate the subjective responses
on the degree of difficulty of the surgical procedure both by the surgical team expert
in CME and by a group of young surgeons.
Results
Statistical analysis showed that overall operative time was significant shorter in
patients underwent to radiological assessment (224,5 min; range 160–300 versus 252,6 min;
range 200–340; p-value 0.023) with a significant lower rate of intraoperative complication
(2.7% versus 4.2%; p-value 0.043). No differences were reported with respect to blood
loss, conversion rate, anastomotic leakage or other surgical results. Analysis of
the questionnaire underlined a progressive awareness of the correspondence between
the radiological imaging and the surgical field.
Conclusion
The possibility of identifying the characteristics and course of the vascular structures
along the axis of the superior mesenteric vessels certainly increases the surgeon's
knowledge of the operating field, making him more confident with surgical maneuvers
and significantly reducing the duration of the operating time and intraoperative complications.
Keywords
Abbreviations:
CME ((Complete Mesocolic Excision)), CVL ((Central Vascular Ligation)), PACS ((Picture Archiving and Communication System))To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 16, 2022
Accepted:
August 10,
2022
Received in revised form:
July 1,
2022
Received:
May 9,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
