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Preoperative anatomical road mapping reduces variability of operating time, estimated blood loss, and lymph node yield in right colectomy with extended D3 mesenterectomy for cancer

  • Christer-Daniel Willard
  • Erik Kjaestad
  • Bojan V. Stimec
  • Bjorn Edwin
  • Dejan Ignjatovic
  • RCC Study Group
Original Article

Abstract

Objective

To assess the impact of individual patient anatomy on operating time, estimated blood loss (EBL), and lymph node yield in right colectomy with extended D3 mesenterectomy, where surgeons have access to a preoperative 3-D reconstruction of the vascular anatomy of patients before surgery.

Aim/summary background data

Data on the impact of individual patient vascular anatomy when surgeons have an anatomical road map as a guide at surgery is still missing in the literature.

Method

Consecutive patients enrolled in an ongoing trial were classified into 4 groups and 2 subgroups using a 3-D vascular anatomy reconstruction derived from the staging CT. Outcome measures are operating time, EBL, vascular events, and D3 volume lymph node yield. SPSS was used for statistical analysis.

Results

One hundred seventy-six (77 men) patients included. Mean operating time was 200 ± 50 min. Type 4b required significantly longer operating time (mean, 219 ± 59) compared to type 3 (mean, 188 ± 43) (p = 0.004). Vascular events occurred most often in anatomy type 4b (20.0%) and 3 (19.2%). No difference in EBL and lymph node yield was found (p = 0.102 and p = 0.803, respectively).

Conclusion

The use of a roadmap at surgery seems to even differences in operating time, EBL, and lymph node yield, independent of the complexity of the individual patient’s central mesenteric vascular anatomy. The incidents of vascular events requiring hemostasis do not cause differences in EBL between the anatomy groups, suggesting that preoperative awareness of the anatomy is beneficial at surgery.

Keywords

Right colectomy Colon cancer 3D vascular anatomy Surgical roadmapping Operating time Estimated Blood Loss Lymph node yield 

Notes

Acknowledgements

The Right Colon Cancer Study Group (RCC-group): Prof. Dr. Tom Oresland, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Prof. Dr. Arne O. Bakka, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Assoc Prof. Ola Reiertsen, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Arne Engebreth Færden, MD, PhD, Akershus University Hospital, Department of Digestive Surgery, Oslo, Norway; Yngve Thorsen, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Prof. Solveig Norheim Andersen, MD, Akershus University Hospital, Department of Pathology, University in Oslo, Norway; Anne Negaard, MD, PhD, Akershus University Hospital, Department of Radiology, Oslo, Norway; Aly Dicko, MD, Department of Digestive Surgery, Haukeland University Hospital, Bergen, Norway; Prof. Frank Pfeffer, MD, Department of Digestive Surgery, Haukeland University Hospital, Bergen, Norway; Hovard Forsmo, MD, Department of Digestive Surgery, Haukeland University Hospital, Bergen, Norway; Sigmund Ytre-Hauge, MD, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Jens Marius Nesgaard MD, Department of Digestive Surgery, Vestfold Hospital Trust, Tonsberg, Norway; Russel Jacobsen, MD, Department of Vascular Surgery, Vestfold Hospital Trust, Tonsberg, Norway; Kari Mette Langerød von Brandis, MD, Department of Radiology, Vestfold Hospital Trust, Tonsberg, Norway; Tania Hansen, Department of Radiology, Vestfold Hospital Trust, Tonsberg, Norway; Pål Suhrke, MD, Department of Pathology, Vestfold Hospital Trust, Tonsberg, Norway; Javier Luzon, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Barış Sevinç, MD, Department of General Surgery, Medical Park Uşak Hospital, Uşak, Turkey; Bjarte Tidemann Andersen, MD, Department of Digestive Surgery, Østfold Hospital Trust, Grålum, Norway; Robin Gaupset, MD, Department of Digestive Surgery, Akershus University Hospital, Oslo, Norway; Prof. Dr. Roberto Bergamaschi, MD, Division of Colorectal Surgery, Westchester Medical Center, New York Medical College, NY, USA; Frieder Pullig, MD Viszeralchirurgie Klinikum Karlsruhe Germany; Ulrich Schneider, MD Institut für Pathologie Klinikum Karlsruhe, Germany; Joerg Baral, MD Viszeralchirurgie Klinikum Karlsruhe Germany; Marcos Gomez Ruiz MD, Coloproctologia Cirugia Colorrectal - Cirugía General y Ap. Digestivo Hospital Universitario Marques de Valdecilla, Spain; Jonas Lindstrøm Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Ariba Ehsan Sheikh, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway; Tine Strommen, MD, Akershus University Hospital, Department of Digestive Surgery, University in Oslo, Norway.

Authors’ contribution

All authors contributed to the conception, design, and data collection. The authors have actively participated both in writing parts of the manuscript and in revising it, and in the end, have given final approval for the manuscript to be published. The study conducted is a cohort study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Digestive Surgery, Akershus University HospitalUniversity of OsloLorenskogNorway
  2. 2.Anatomy Sector, Department of Cell Physiology and Metabolism, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  3. 3.Interventional Centre, Gastrointestinal and Pediatric SurgeryOslo University Hospital–RikshospitaletOsloNorway
  4. 4.Institute of Clinical MedicineUniversity of OsloOsloNorway

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