Preoperative Radiological Evaluation Research Articles

Endoscopic transnasal repair of cerebrospinal fluid leaks with and without an encephalocele in pediatric patients: from infants to children.

The diagnosis and management of pediatric cerebrospinal fluid (CSF) leak and encephalocele are challenging. The current study aimed to identify patient characteristics, review operative techniques, and evaluate the efficacy and safety of endoscopic endonasal repair in a pediatric population. We retrospectively reviewed the records of pediatric patients who underwent transnasal endoscopic repair of CSF leak with or without a meningocele or an encephalocele at Beijing Tongren Hospital, Capital Medical University, between July 2003 and May 2014. All patients had preoperative radiological evaluations and underwent endoscopic endonasal repair of their skull base defects. Altogether, 23 children (mean age 7.0 years) underwent the procedures. Sixteen cases were congenital, and 7 patients had trauma history. The herniations or defects included meningoencephaloceles in 15 cases, meningoceles in 4 cases, and CSF leak in 4 cases (2 patients had bilateral leaks). The leak or herniation sites were ethmoid roof in 10 patients (one was bilateral), cribriform plate in 5, lateral to the foramen cecum in 3, posterior wall of the frontal sinus in 1, sphenoid sinus in 2, lateral recess of the sphenoid sinus in 1, and sella turcica base in 2. All subjects had favorable clinical outcomes without recurrence during a follow-up of 6-123 months (mean 61.1 months). The endoscopic endonasal approach was the preferred method for repairing CSF leaks with or without an encephalocele in pediatric patients. Compared to traditional operations, this endoscopic procedure is minimally invasive, efficient, and safe.

Anatomical study of posterior clinoid process (PCP) and its clinical meanings.

The aim of this study is to provide a new and comprehensive anatomic study of the posterior clinoid process (PCP) as well as data for PCP location to guide the surgeons in endoscopic surgery. Computed tomography angiography images of 120 PCPs and structures around them in adults were reviewed. The measurement was on coronal, sagittal, and axial planes after multiplanar reconstruction. The length, width, and thickness were accessed for the best understanding of the feature of PCP. The distance from the base of the PCP and the middle lowest point of the sellar floor was measured to find the position of the PCP during the transphenoid approach. PCP varies in width and thickness in different portions of it and is closely related to the internal carotid artery and posterior communicating artery, which makes it an important landmark during surgery. The shape of PCP is various, and the analysis of its relationship to the important structures around it is of great value. In addition, the preoperative radiological evaluation plays a major role in patients considered for endoscopic sinus surgery. Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications.

Associated liver and multivisceral resections: should we extend the frontiers of resectability?

Combined liver and multivisceral resections (CLMVRs) are rare procedures that demand extensive surgical skills. Few reports have discussed the benefit of these complex procedures and their indications are poorly defined. The aim of the present study is to present short- and long-term results of CLMVRs in primary and metastatic malignancies, including a risk analysis for perioperative morbidity and mortality. A review of our prospective surgical database between November 2007 and August 2013 identified 21 patients who had undergone CLMVRs. Preoperative radiologic evaluation and laboratory data, intraoperative results, hospital outcomes, and long-term follow-up were analyzed. CLMVRs were performed due to metastatic disease from different sites in 17 patients, and due to direct local invasion of the liver in the remaining 4 cases. Major hepatectomy was performed in 7 cases. Morbidity was 57% and 90-day postoperative mortality was 9%. Gender and resection of more than 4 organs were found as statistically significant risk factors to develop major complications. Five of 7 patients with 4 or more organs resected presented major complications including mortality (p = 0.026). The overall 1- and 3-year survival rates were 57 and 24%, respectively. Patients undergoing CLMVRs experience acceptable postoperative morbidity and mortality rates. Surgery should be performed only in carefully selected patients, considering their preoperative comorbidities, and in high-volume centers.

Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma

ObjectivesPapillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors.MethodsTwo hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis.ResultsMultifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6±1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32±0.18 cm) than the primary tumors (0.63±0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors.ConclusionIn cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up.

Intracranial repair of posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis.

The purposes of this study are to assess the efficacy of our intracranial surgery and evaluate the association between failure after first surgical repair and the risk factors that have been applied on a group of 13 patients affected by posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis. We retrospectively collected data on 13 patients referred to our institution. All patients had history of head trauma and experienced 2 or more episodes of meningitis. Three of the 13 patients had craniectomy defect due to previous trauma and surgery, 9 patients had linear fracture, and 1 patient had no apparent fracture line on preoperative radiologic evaluation. Ten of the 13 patients had identified frontal bone fracture involving the frontal sinus during surgery. Dural tear was identified intradurally and was repaired using a fascia lata graft with or without fibrin glue. Fibrin glue was applied over the suture in 7 patients. Three of the 13 patients had large dural defects. The size of bone and dural defect seems to be an important prognostic factor of episodes of meningitis. The use of fibrin glue to fixate fascia lata graft did not benefit the outcome.

Surgical outcome of endoscopic versus microscopic trans-sphenoidal approach for pituitary adenomas

Objective The aim of the study was to compare between endoscopic and microscopic trans-sphenoidal approach regarding surgical outcome and postoperative complications. Background Pituitary adenomas are the third most common intracranial tumors in surgical practice, accounting for ~10-25% of intracranial tumors. These tumors may gain large size before producing hormonal or visual symptoms. There are many surgical approaches for these tumors. Patients and methods Over the last 3 years, 40 patients with pituitary adenoma either microadenoma or macroadenoma were operated through trans-sphenoidal approach either microscopically or endoscopically. Patient consent was obtained followed by careful clinical history, symptoms, signs, and preoperative radiological evaluation. Operative and postoperative events were noted with 3 months follow-up. Results A total of 40 patients with pituitary adenomas were operated trans-sphenoidally. The mean age was 35.9 years (range 21-60 years). The number of men was 23 (57.5%) and women was 17 (42.5%). The most common presenting symptom was headache in 25 (62.5%) patients and visual complaints in 24 (60%) patients. Amenorrhea and acromegaly were in eight (20%) patients for each; Cushing syndrome was present in three (7.5%) patients. Hyperthyroidism and infertility were in two (5%) patients for each. Conclusion Surgical outcome in endoscopic trans-sphenoidal approach is better than microscopic approach regarding postoperative nasal complications.

Evaluation of fixed-bearing arthroplasty in primary total knee replacement

Background Fixed-bearing primary total knee replacement is a well-established method of treatment for advanced arthritic knee joint. Aim of the study This study evaluated the clinical, functional, and radiological outcomes after the use of fixed-bearing total knee arthroplasty in cases of primary total knee replacement. Patients and method This prospective study was conducted on 14 patients (six male and eight female) who attended Suez Canal University Hospitals between January 2012 and January 2013, and the mean age was 60 years (range 50-72 years) at the time of surgery. The patients included in the study had advanced unilateral knee osteoarthritis with severe pain and functional disability with failure of conservative measures. Preoperative clinical and radiological evaluation was carried out and the knee society clinical and functional rating system (KSS) was used to evaluate the patients preoperatively and postoperatively at 1-year follow-up. The scoring system combines a relatively objective knee score that is based on the clinical parameters and a functional score based on how patients perceive their knee function in relation to specific activities. Radiological evaluation was carried out to determine the alignment of the knee and the femoral and tibial component positions. Results There was significant difference between preoperative and postoperative clinical and functional scores. The mean postoperative clinical assessment score for pain was 44.9, for range of motion it was 115.9, and for stability it was 23.5. Postoperative mean knee society clinical assessment score was 90.7 and the mean functional assessment score for knee function was 87.5. According to the knee society clinical and functional score, 85% of patients had excellent results and 15% of patients had good results. As regards radiological results, all knees were well-aligned at 1 year postoperatively and no periprosthetic loosening or radiolucent line around either component was found. Conclusion Primary total knee arthroplasty using fixed-bearing prosthesis is an effective procedure with good clinical and functional results and early mobilization.

Mean arterial pressure associates with uncoupled remodeling of subchondral bone in patients with knee osteoarthritis

Mean arterial pressure associates with uncoupled remodeling of subchondral bone in patients with knee osteoarthritis

An unusual case of mixed polydactyly of foot

A common congenital anomaly, polydactyly refers to supernumerary digits of the hand or foot, the incidence of which varies widely according to race, geographical location, familial syndromes and other environmental factors. The foot tends to be more rarely involved than the hand. These images depict a 60-year-old Hindu male with polydactyly of the right foot since birth. Digital radiography of the right foot showed a combination of Y-shaped metatarsal, T-shaped metatarsal, block metatarsal and duplicated rays. There was no sign or symptom of a syndromic anomaly. The disorder appeared to be purely sporadic in nature. The patient displayed unilateral polydactyly with eight digits that included a combination of Yshaped metatarsal, T-shaped metatarsal, block metatarsal and duplicated rays; this is an uncommon presentation. Polydactyly of the foot is a rare disorder which may present sporadically, or in conjunction with familial syndromes; hence, accurate, genetic diagnosis is essential for proper management. Thorough preoperative radiological and anatomical evaluation is mandatory for effective reconstruction of the digit.

Outcomes of Periradicular Surgery of Maxillary First Molars Using a Vestibular Approach: A Prospective, Clinical Study With One Year of Follow-Up

The aim of the present prospective, randomized, controlled, clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods: cone beam computed tomography (CBCT) and conventional radiography. Periradicular surgery was applied to the maxillary first molar tooth in 40 patients. The patients were divided into 2 groups. The patients in group 1 underwent examination and preoperative planning with CBCT, and the patients in group 2 underwent examination and preoperative planning with conventional radiography. The outcomes of the treatment were evaluated radiographically and clinically, and the data were analyzed statistically. The mean operative time was significantly shorter in group 1 than in group 2. According to the radiographic and clinical healing criteria used in the present study, the healing of patients in group 1 was rated as a success in 35%, an improvement in 40%, and a failure in 25%. In the group 2 patients, healing was rated as a success in 42.1%, an improvement in 31.6%, and a failure in 26.3%. Sinus membrane elevation was performed in 92.3% of all patients. Sinus membrane perforation occurred in 20% of the patients in group 1 and 36.8% of the patients in group 2. Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate. Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes.

Non-recurrent inferior laryngeal nerve identification during robotic thyroidectomy

A non-recurrent inferior laryngeal nerve is a rare anomaly in which the nerve enters the larynx directly off the cervical vagus nerve, without descending to the thoracic level. It is very susceptible to damage during surgery. This report describes the important pre-operative radiological evaluations and surgical landmarks in a case of a non-recurrent inferior laryngeal nerve, identified during the recently developed technique of robotic thyroidectomy. A 38-year-old woman presented with suspected papillary microcarcinoma, as indicated by aspiration cytology. Pre-operative computed tomography showed a right aberrant subclavian artery that indicated a possible right non-recurrent inferior laryngeal nerve. Using robotic thyroidectomy methods, it was possible to carefully dissect along the thyroid capsule. The laryngeal entrance point of the right non-recurrent inferior laryngeal nerve (a constant anatomical landmark) was successfully identified via the three-dimensional, high-magnification views provided by the robotic endoscope. With proper knowledge of radiological and surgical anatomy, and the benefits of high-magnification endoscopic views, a non-recurrent inferior laryngeal nerve can be safely preserved during robotic surgery.

Discrepancy between preoperative MRI evaluation and intraoperative or postoperative pathological findings for the extent of local invasion in maxillary squamous cell carcinoma

Preoperative radiological evaluation of the extent of local invasion in maxillary squamous cell carcinoma (SCC) is very important in planning curative surgery. The aim of this study was to examine the accuracy of preoperative radiological evaluation with magnetic resonance imaging (MRI) for the extent of local invasion in maxillary SCC. A retrospective study was conducted of 33 patients who underwent a maxillectomy for maxillary SCC. We compared the MRI findings for 18 structures around the maxillary sinus with intraoperative or postoperative pathological findings. Discrepancies were found between preoperative MRI findings and intraoperative or postoperative pathological findings for 22 patients (66.7%). Overall, the specificity, sensitivity, positive predictive value, and negative predictive value of MRI were 83.4%, 83.0%, 64.5%, and 90.4%, respectively. The receiver operating characteristic curve showed that MRI evaluation of the posterolateral structures including the pterygoid plate, pterygoid muscle, and infratemporal fossa had a lower area under the curve (0.614) and a significantly lower accuracy when compared with the other structures (P=0.294, 95% confidence interval 0.405–0.822). In conclusion, as the accuracy of preoperative MRI evaluation of the posterolateral structures is low, careful evaluation of local extension to the posterolateral structures is needed when planning curative surgery for maxillary SCC.

Cervical Conization and Sentinel Lymph Node Mapping in the Treatment of Stage I Cervical Cancer: Is Less Enough?

This study aimed to determine the feasibility of cervical conization and sentinel lymph node (SLN) mapping as a fertility-sparing strategy to treat stage I cervical cancer and to estimate the tumor margin status needed to achieve no residual carcinoma in the cervix. We identified all patients who desired fertility preservation and underwent SLN mapping with cervical conization for stage I cervical cancer from September 2005 to August 2012. Relevant demographic, clinical, and pathologic information was collected. Ten patients were identified. Median age was 28 years (range, 18-36 years). None of the patients had a grossly visible tumor. The initial diagnosis of invasive carcinoma was made either on a loop electrosurgical excision procedure or cone biopsy. All patients underwent preoperative radiologic evaluation (magnetic resonance imaging and positron emission tomography-computed tomography). None of the patients had evidence of gross tumor or suspicion of lymph node metastasis on imaging. Stage distribution included 7 (70%) patients with stage IA1 cervical cancer with lymphovascular invasion and 3 (30%) patients with microscopic IB1. Histologic diagnosis included 8 (80%) patients with squamous cell carcinoma, 1 (10%) patient with adenocarcinoma, and 1 (10%) patient with clear cell carcinoma. Nine patients underwent repeat cervical conization with SLN mapping, and 1 patient underwent postconization cervical biopsies and SLN mapping. None of the patients had residual tumor identified on the final specimen. The median distance from the invasive carcinoma to the endocervical margin was 2.25 mm, and the distance from the invasive carcinoma to the ectocervical margin was 1.9 mm. All collected lymph nodes were negative for metastasis. After a median follow-up of 17 months (range, 1-83 months), none of the patients' conditions were diagnosed with recurrent disease and 3 (30%) patients achieved pregnancy. Cervical conization and SLN mapping seems to be an acceptable treatment strategy for selected patients with small-volume stage I cervical cancer. Tumor clearance of 2 mm and above seems to correlate well with no residual on repeat conization. A larger sample size and longer follow-up is needed to establish the long-term outcomes of this procedure.

Primary malignant fibrous histiocytoma of the renal pelvis: a 78-month follow-up case report

Primary malignant fibrous histiocytoma of the renal pelvis is extremely rare. This article reports a pathologically confirmed case. Surgery is the main treatment for this disease. Chemotherapy and radiotherapy have been reported to be ineffective. It is difficult to differentiate it from urothelial tumor of the renal pelvis and renal cell carcinoma by preoperative laboratory and radiological evaluation. Immunohistochemical study is helpful in confirming the diagnosis of the disease. This report discusses the clinical manifestations, pathohistological characteristics, treatment, and prognosis of the case reported.

Diagnostic value of apparent diffusion coefficient for the accurate assessment and differentiation of intracranial meningiomas

BackgroundDiffusion-weighted imaging (DWI) along with the calculation of apparent diffusion coefficient (ADC), is a novel, non-invasive, and reliable technique of choice for accurate assessment and for the treatment planning of different types of brain tumors. It is more advantageous in the distinction and differentiation of benign from malignant meningiomas on the basis of ADC values.PurposeTo investigate the utility of DW magnetic resonance imaging (MRI), and to compare the apparent diffusion coefficient (ADC) obtained at two b-values for an authentic and preoperative characterization of meningiomas.Material and MethodsTwenty-six patients with clinically diagnosed or histologically verified meningioma (18 benign and 8 malignant) underwent imaging including DWI at 1.5 T. DW images were obtained at b = 1000 s/mm2 and b = 2000 s/mm2, ADC maps were generated at both the b-values. Signal intensities (SIs) and ADCs for solid tumorous tissues, contralateral normal tissues, and peritumoral edema were calculated and normalized ADC (NADC) ratio were determined for tumorous tissues. SI scores, ADC maps, and ADC values were analyzed visually and quantitatively, and were compared at both the b-values.ResultsDW images at b = 2000 s/mm2 were more conspicuity (either hyperintense or hypointense) with improved contrast. The mean ADC of malignant meningiomas (0.64 ± 0.05 and 0.42 ± 0.03) was significantly lower (P < 0.05) as compared with benign meningiomas (1.04 ± 0.12 and 0.80 ± 0.07) at both the b-values. Mean NADC ratio in the malignant type was also significantly lower (P < 0.05) than the benign type at both the b-values. Mean ADC values for peritumoral edema do not differ between benign and malignant meningiomas.Conclusion1.5-T DWI using high b-values improved our ability to differentiate benign from malignant meningiomas. DWI may play an important role in the preoperative radiological evaluation and the recognition of these types for proper surgical treatment.

Transoral Robotic Surgery in Head and Neck Cancer: What Radiologists Need to Know about the Cutting Edge

The evolution of oncologic surgical technology has moved toward reducing patient morbidity and mortality without compromising oncologic resection or oncologic outcomes. The goals in treating head and neck cancer are to cure patients, as well as to provide quality of life by improving functional and social outcomes through organ-preservation therapies, which may include surgery, chemotherapy, and/or radiation therapy. Transoral robotic surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens and over open surgery for head and neck cancer, including reductions in operative times, blood loss, intensive care unit stays, and overall duration of patient hospitalization. Transoral robotic techniques allow wide-view, high-resolution, magnified three-dimensional optics for visualization of the mucosal surfaces of the head and neck through an endoscope, while avoiding the extensive external cervical incisions often required for open surgeries. Radiologists play an important role in the successful outcome of these procedures, both before and after TORS. Determining a cancer patient's surgical candidacy for TORS requires a thorough preoperative radiologic evaluation, coupled with clinical and intraoperative assessment. Radiologists must pay particular attention to important anatomic landmarks that are clinical blind spots for surgeons. Knowledge of the expected postoperative imaging appearances, so that they can be distinguished from recurrent disease and second primary tumors, is essential for all radiologists involved in the care of these patients.

AUGIS trainee prize winner: Antimicrobial prophylaxis prior to pancreatico-duodenectomy

AUGIS trainee prize winner: Antimicrobial prophylaxis prior to pancreatico-duodenectomy

Posterior fixation of type IV humeral capitellum fractures with fully threaded screws in adolescents.

Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures. Eight adolescent patients (six male, two female) with a mean age of 15±2.1 years (range 13-18years) were treated for type IV (McKee) humerus capitellum fractures. In the preoperative radiological evaluation, anteroposterior and lateral radiographs and computed tomography (CT) images were performed. A lateral surgical approach was used, and cannulated fully threaded headless screws were applied in a posteroanterior direction as fixation materials in the fracture reduction. The Mayo Elbow Performance Score was used in the evaluation of elbow joint functions. Patients were followed up for a mean of 24.6 months. Fracture union was achieved at a mean of 5±0.92 weeks (range 4-6weeks). The mean elbow extension flexion arc was 135°±13.47° (range 110°-150º) and the mean pronation supination arc was 156°±4.43° (150°-160°). In one patient, there was nonconformity in the humerus trochlea and in another patient, there was keloid formation on the surgical scar. All patients attained excellent results according to the Mayo Elbow Performance Score. In the treatment of type IV capitellum fractures in adolescents, open reduction with a lateral surgical approach and fixation using posteroanterior directed, cannulated, fully threaded, headless screws is a reliable method to achieve a pain-free functional elbow joint.

Preoperative and Intraoperative Evaluation of Pancreatic Cancer with Vascular Involvement

Context Pancreatic carcinoma, even though distant metastases are not detectable, extends directly into the retroperitoneal spaces and involves the superior mesenteric vein (SMV) or portal vein (PV) in 25% of cases. Evidences show that patients who underwent pancreatectomy with PV and/or SMV resection and those who underwent radical resection for localized tumors, may have a comparable long term survival. Multidetector computed tomography (CT) with three-dimensional (3-D) reconstruction is an essential tool to accurately stage the disease in an attempt to identify patients who would benefit from attempted curative resection. Objective The aim of this study is to compare the results of preoperative radiological (multislice CT) evaluation with the intraoperative and histopathological findings in terms of mesenteric vessels involvement. Methods Between 2006 and 2013 we performed 130 pancreatic resections. Preoperatively, all patients underwent clinical staging with multislice CT with contrast and multiplanar reconstruction (MPR). Radiological findings were compared with surgical and histopathological results. Results Twenty cases (15.4%) radiologically showed a vascular involvement. However at laparotomy, a venous vascular resection was only performed in 10/20 cases (50%). As regard the vascular reconstruction, we performed in 3 cases a continuous suture after a tangential resection, in 7 cases a segmental resection with autologous graft interposition (with right internal jugular vein in 4 cases and with left renal vein in 1), and in 2 case a segmental resection with direct suture previous hepatic mobilization. The postoperative course had no major complications. Histological examination of resected vein wall showed: in 3 case a neoplastic infiltration limited to tunica adventitia, in 5 cases an involvement of tunica media, in 1 case an extension to intima and in 1 case there was no neoplastic infiltration. Conclusions When there are no distant metastasis, surgical radical resection provides the only chance for cure or long-term survival. In pancreatic tumors with PV/SMV involvement (borderline pancreatic cancers), oncologic radicality (negative resection margins: R0) must provide a vascular resection that actually have low morbidity and mortality. We also must consider that in more than 50% of patients the radiological vascular involvement is not confirmed at laparotomy.

Preoperative and intraoperative evaluation of pancreatic cancer with vascular involvement

Pancreatic carcinoma, even though distant metastases are not detectable, extends directly into the retroperitoneal spaces and involves the superior mesenteric vein (SMV) or portal vein (PV) in 25% of cases. Evidence shows that patients who underwent pancreatectomy with Portal Vein (PV) and/or Superior Mesenteric Vein (SMV) resection and those who underwent radical resection for localized tumours, may have a comparable long term survival. Multidetector computed tomography (CT) with three-dimensional (3-D) reconstruction is an essential tool to accurately stage the disease in an attempt to identify patients who would benefit from attempted curative resection. The aim of this study is to compare the results of preoperative radiological (multislice CT) evaluation with the intraoperative and histopathological findings in terms of mesenteric vessels involvement.