Abstract
BackgroundThe reliability of the registered ligation level of the inferior mesenteric artery (IMA) in the Swedish Colorectal Cancer Registry has been questioned. The primary aim of this study was to evaluate this parameter in the registry by comparing the registered ligation levels with a postoperative computed tomography angiography (CT-angiography) in patients operated for rectal cancer.MethodsPatients operated for rectal cancer at two Swedish university hospitals were prospectively included between December 2016 and December 2019. At the 1-year postoperative follow-up, an additional CT-angiography was performed and independently examined by two radiologists. The radiological assessment of the ligation level was compared to registry data, using different measures of agreement.ResultsA total of 94 patients were included, 55 (59%) were men and 39 (41%) women. All patients underwent abdominal resection: conventional or robot-assisted laparoscopic surgery, n=56 (60%), or open resection, n=38 (40%). The ligation level as assessed on CT-angiography was high in 29 (31%) patients and low in 65 (69%). The registered level of ligation of the IMA and the radiological assessment of the CT-angiographies were consistent in 77/94 cases, demonstrating an 82% agreement and a sensitivity and specificity of 86% and 72%, respectively. The estimated Kappa value was 0.58, reaching 0.64 after prevalence bias adjustment.ConclusionThis study showed that CT-angiography can be used to evaluate the reliability of the registered ligation level in the Swedish Colorectal Cancer Registry. The demonstrated agreement between the registry and postoperative CT-angiography was moderate to good. This discrepancy impacts registry-based research using IMA ligation data and may ultimately influence surgical practice.Trial registrationClinical Trials identifier NCT03875612
Highlights
Abdominal resection for rectal cancer includes ligation of the inferior mesenteric artery (IMA), either proximal or distal to the branching of the left colic artery [1, 2]
The primary aim of this study was to evaluate the validity of the registered ligation level of the IMA in abdominal rectal cancer surgery in the Swedish Colorectal Cancer Registry (SCRCR), as compared with the reference provided by radiological assessment from postoperative Computed tomography (CT)-angiography
Eleven patients were excluded: the remaining IMA and branches were thrombosed in such a way that the radiological ligation level was not possible to determine (n=5), the CT-angiography was not performed at the same time as the postoperative follow-up control (n=4), severe renal impairment contraindicated a CT-angiography (n=1), and death before the planned CT-angiography (n=1)
Summary
Abdominal resection for rectal cancer includes ligation of the inferior mesenteric artery (IMA), either proximal (high ligation) or distal to the branching of the left colic artery (low ligation) [1, 2]. A low ligation is less invasive, might improve the collateral blood supply to the residual colon with a possibly lower risk of anastomotic ischemia and subsequent leakage, and carries lower risk of damage to the sympathetic autonomic nerve plexus adjacent to the proximal part of the IMA [11,12,13]. The reliability of the registered ligation level of the inferior mesenteric artery (IMA) in the Swedish Colorectal Cancer Registry has been questioned. The primary aim of this study was to evaluate this parameter in the registry by comparing the registered ligation levels with a postoperative computed tomography angiography (CT-angiography) in patients operated for rectal cancer
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