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Abstract
BackgroundUnderstanding the vascular anatomy is critical for performing central vascular ligation (CVL) in right hemicolectomy with complete mesocolic excision (CME). This study aimed to investigate the predictive value of multi-slice spiral computed tomography (MSCT) with coronal reconstruction in right hemicolectomy with CME.MethodsThis is a retrospective descriptive study. Eighty patients with right colon cancer who underwent right hemicolectomy from December 2015 to January 2020 were included. The intraoperative reports (including imaging data) and MSCT images with coronal reconstruction were analysed and compared. The detection rates of the ileocolic vein (ICV) and ileocolic artery (ICA) roots and the accuracy in predicting their anatomical relationship were analysed. The detection rate and accuracy in predicting the location of the gastrocolic trunk of Henle (GTH), middle colic artery (MCA) and middle colic vein (MCV) were analysed. The distance from the ICV root to the GTH root (ICV-GTH distance) was measured and analysed. The maximum distance from the left side of the superior mesenteric artery (SMA) to the right side of the superior mesenteric vein (SMV), named the ‘lsSMA-rsSMV distance’, was also measured and analysed.ResultsIn seventy-four (92.5%) patients, both the ICV and ICA roots were located; their anatomical relationship was determined by MSCT, and the accuracy of the prediction was 97.2% (72/74). The GTH was located by MSCT in 75 (93.7%) patients, and the accuracy of the prediction was 97.33% (73/75). The MCA was located by MSCT in 47 (58.75%) patients, and the accuracy was 78.72% (37/47). The MCV was located by MSCT in 51 (63.75%) patients, and the accuracy of the prediction was 84.31% (43/51). The ICV-GTH distance was measured in 73 (91.2%) patients, and the mean distance was 4.28 ± 2.5 cm. The lsSMA-rsSMV distance was measured in 76 (95%) patients, and the mean distance was 2.21 ± 0.6 cm.ConclusionsWith its satisfactory accuracy in predicting and visualising the information of key anatomical sites, MSCT with coronary reconstruction has some predictive value in CME with CVL in right hemicolectomy.
Highlights
Understanding the vascular anatomy is critical for performing central vascular ligation (CVL) in right hemicolectomy with complete mesocolic excision (CME)
With its satisfactory accuracy in predicting and visualising the information of key anatomical sites, multi-slice spiral computed tomography (MSCT) with coronary reconstruction has some predictive value in CME with CVL in right hemicolectomy
Inclusion and exclusion criteria The inclusion criteria were as follows: right-sided colon cancer treated with right hemicolectomy; plain abdominal and pelvic and contrast-enhanced triple-phase MSCT scans performed before the operation, and original data that was available for reconstruction
Summary
Understanding the vascular anatomy is critical for performing central vascular ligation (CVL) in right hemicolectomy with complete mesocolic excision (CME). It is important to note that CME should be performed under the principle of central vascular ligation (CVL), which includes nearly full-length skeletonisation of the superior mesenteric vessels during right hemicolectomy, and this procedure was considered an extended dissection according to S. Right hemicolectomy can be performed through the following different approaches: cephalic approach, caudal approach, and central approach Amongst these approaches, the central approach is usually considered the most consistent with the principle of radical tumour resection, which first requires dissection and ligation of the vessel roots in the superior mesenteric vascular region. A lack of proper understanding of the vascular anatomy and central vascular ligation region might lead to intraoperative injury, bleeding and inadequate lymph node clearance and increases the difficulty of performing CME with CVL [12, 13]
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