Routine CT evaluation of central vascular ligation in patients undergoing complete mesocolic excision for sigmoid colon cancer.

Abstract

Objective and reproducible quality measures of complete mesocolic excision (CME) for colon cancer are not currently available. This study aimed to measure the inferior mesenteric stump length following CME for sigmoid colon cancer and explore surgical, pathological and oncological outcomes in patients with a stump length of <10mm vs. ≥10mm. This was a single-centre, retrospective cohort study including patients undergoing minimally invasive surgery for sigmoid colon cancer between May 2013 and May 2015. Follow-up CT scans were reviewed, and a vascular stump cut-off of <10mm for adequate central ligation of the inferior mesenteric artery was applied. Differences in perioperative, histopathological and oncological outcome parameters (overall, disease-free and recurrence-free survival) were explored between <10mm vs. ≥10mm groups. A total of 127 patients (43% female) with a median age of 68years were included. The median follow-up time was 68months. CT measurements showed good interrater agreement (90% absolute agreement) and reliability among raters (kappa=0.77, 95% CI 0.53-1.00, p<0.001). A stump length ≥10mm was associated with longer operating time (150 vs. 180min, p=0.021), intramesocolic resection (p=0.008), and a shorter distance from the bowel wall to vascular tie (120 vs. 102mm, p=0.005). An arterial stump length ≥10mm in sigmoid resection for colon cancer was associated with key clinical quality measures. Measurement of arterial stump length using routine follow-up CT may serve as a quality indicator of vascular ligation in CME surgery.