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Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer.

Methods

In this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery.

Results

In the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05).

Conclusions

For laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.

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Funding

This study is funded by Jiangsu Provincial Health and Family Planning Commission for young talent’s subsidy in science and education (QNRC2016146) and Wuxi Science and Technology Bureau Project (CSE31N1707)

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Authors and Affiliations

  1. Department of Radiology, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, 68 Zhongshan Road, Jiangsu, 214002, People’s Republic of China

    Linjie Bian, Danping Wu, Zhuiyang Zhang, Jianming Ni & Lei Zhang

  2. Department of General Surgery, The Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University, 68 Zhongshan Road, Jiangsu, 214002, People’s Republic of China

    Yigang Chen & Jiazen Xia

Authors
  1. Linjie Bian
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  2. Danping Wu
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Contributions

Each author has participated sufficiently in the work and will take public responsibility for appropriate portions of the content. Linjie Bian and Danping Wu conceived of the idea for the study and developed the study design. Linjie Bian and Zhuiyang Zhang collected CT data and analytical images. Yigang Chen and Jiazeng Xia collected clinical and surgical data. Jianming Ni and Lei Zhang carried out the clinical trial registration and the ethical approvement procedure. All the images are interpreted by Yigang Chen and Linjie Bian. Linjie Bian and Danping Wu performed the statistical analyses (SPSS), wrote the manuscript and together made revisions and approved the final manuscript. Both authors read and approved the final manuscript.

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Correspondence to Yigang Chen.

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Bian, L., Wu, D., Chen, Y. et al. Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial. J Gastrointest Surg 24, 2822–2828 (2020). https://doi.org/10.1007/s11605-019-04460-1

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