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Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

World Journal of Gastrointestinal Oncology 2019年第3期11卷 208-226页

作者： Cristian Livadaru Stefan Morarasu Tudor Cristian Frunza florina A Ghitun elena florina paiu-spiridon florina Sava Cristina Terinte Dan Ferariu Sorinel Lunca Gabriel Mihail Dimofte "Grigore T Popa" University of Medicine and Pharmacy 2~(nd) Clinic of Surgical Oncology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy Department of Radiology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy Department of Pathology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy

BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely acclaimed as the new goldstandard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME *** To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical *** This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation(group A) and non-standardized surgery(group B). The two groups were compared with regard to the arterial stump length after right-and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery(ICA) and inferior mesenteric artery(IMA) were compared with their theoretical best D2 position of predicted ligation levels(D2 PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded(specimen length, lymph node yield) and correlated with stump *** We analysed 58 colectomies. The stump lengths(mean ± SD) in group A were16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm(χ~2 = 27.38, P < 0.001),which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly re

关键词： Complete mesocolic excision Central vascular ligation Colon surgery Arterial stump measurement Computed tomography

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