The Anatomical and Surgical Consequences of Right Colectomy for Cancer

Spasojevic, Milan; Štimec, Bojan; Grønvold, Lars Bergene; Nesgaard, Jens-Marius; Edwin, Bjørn; Ignjatović, Dejan

doi:10.1097/dcr.0b013e318232116b

Cited by 39 publications

(33 citation statements)

References 16 publications

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“…Our findings are similar to earlier studies that also found a much longer residual arterial stump length than would be expected [12,27].…”

Section: Discussionsupporting

confidence: 83%

“…This distance records the length of the main supplying vessel removed, which is known to be highly variable between individuals [10,11] and the technique cannot assess the length of the tumour feeding artery left behind inside the patient. A recent Norwegian study based on post-operative CT-scans following complications necessitating imaging demonstrated that a much longer stump of artery was left inside the patient than that expected [12]. With optimal CME surgery and high tie ligation we would expect the vessel to be no longer than 10 millimetres (mm).…”

Section: Introductionmentioning

confidence: 99%

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Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

et al. 2017

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There are no conflicts of interest Word count:Text: 2992 Abstract: 250Colon-CT study -3 - Abstract:Aim: Complete mesocolic excision for colon cancer includes central division of the tumour feeding artery. The degree of central radicality is assessed by measuring the distance from the tumour to the artery ligation by the pathologist on the resected specimen. As the length of the artery is highly variable between individuals, this technique may not be the most accurate measure of radicality as it cannot assess the length of the artery left behind inside the patient. The aim was to visualize the length of the tumour feeding artery after surgery and compare the relationship to pathological measures.Method: The length of the arterial stump was measured from the origin to the ligation point on a CT-scan two days post-operatively. This was done by a specialized radiologist who was blinded to operative procedure.Results: 52 patients had the required CT images. The mean length of the residual arterial stump was 38 mm, which was significantly longer than the expected length of <10 mm (p<0.0001). On the right side, the mean length was 31 mm and independent of the relation to the superior mesenteric vein. On the left side, the mean length was 49 mm. There was no correlation between the residual arterial stump and the pathological measures of specimen radicality.Conclusions: The residual arterial stumps measured by post-operative CT were longer than expected even on the right side where a CME was attempted.. Caution should be taken when using pathological measures as an estimation of a central ligation.Colon-CT study -4 -What does this paper add to the literature? This is the first study that measures the length of the remaining arterial stump after colon cancer surgery in a prospective and consecutive cohort. Furthermore, the results are compared to the pathological measures of central radicality on the specimen resected and we found no correlation.

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“…Our findings are similar to earlier studies that also found a much longer residual arterial stump length than would be expected [12,27].…”

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

et al. 2017

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“…Similarly, they found that a postoperative computed tomographic (CT) scan can visualize the arterial stumps and that these stumps appear to be significantly longer than previously anticipated, implying that there is a significant improvement potential when surgical D3 dissection techniques are applied. 16 …”

Section: Lymph Node Harvestmentioning

confidence: 99%

“…Similarly, recently published papers have shown promising results related to the new innovative techniques of D3 resection of the right hemicolon. 16,17 In our opinion, a tailored and individualized preoperative planning of surgery is needed, especially due to the significant anatomical variance in the D3 area.…”

Section: The Future Of Tailored Crc Treatmentmentioning

confidence: 99%

Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations

Augestad

Merok

Ignatovic

2017

Clin Med Insights Oncol

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Colorectal cancer (CRC) is a complex cancer disease, and approximately 40% of the surgically cured patients will experience cancer recurrence within 5 years. During recent years, research has shown that CRC treatment should be tailored to the individual patient due to the wide variety of risk factors, genetic factors, and surgical complexity. In this review, we provide an overview of the considerations that are needed to provide an individualized, patient-tailored treatment. We emphasize the need to assess the predictors of CRC, and we summarize the latest research on CRC genetics and immunotherapy. Finally, we provide a summary of the significant variations in the colon and rectal anatomy that is important to consider in an individualized surgical approach. For the individual patient with CRC, a tailored treatment approach is needed in the preoperative, operative, and postoperative phase.

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“…[4][5][6][7] Patients with transverse colon cancer were often excluded from previous randomized controlled trials because it was difficult to determine the appropriate extent of lymph node dissection, and because the technical difficulties depend on the identification and lymph node dissection around the middle colic vessels, which have a variable anatomy. [5][6][7][8][9] The recent development of multidetector computed tomography (MDCT) has made it possible to perform three-dimensional CT angiography (3DCTA). Many studies have shown that MDCT is an accurate modality for imaging the anatomy of visceral arteries and veins.…”

mentioning

confidence: 99%

Preoperative Assessment of Vascular Anatomy by Multidetector Computed Tomography Before Laparoscopic Colectomy for Transverse Colon Cancer: Report of a Case

Kawamoto

Inoue

Okigami

et al. 2015

International Surgery

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Although the safety of laparoscopic surgery for colon cancer has been reported in many randomized controlled trials, concerns about the difficulty of surgery for transverse colon cancer has not been fully resolved, mainly because of the variation in the vascular anatomy of mesenteric vessels, which leads to difficulty in determining the optimal operative procedure and the extent of lymph node dissection. We present the case of a patient with transverse colon cancer who underwent laparoscopic surgery after preoperative assessment using a combination of endoscopic clipping and threedimensional computed tomography angiography (3DCTA). A 68-year-old man was diagnosed with transverse colon cancer, and laparoscopic surgery has been planned. 3DCTA showed right-middle and left-middle colic arteries arising independently from the superior mesenteric artery. The relationship between the clip and vessels showed that the right-middle colic artery was the feeding artery of the tumor. Operative findings were consistent with 3DCTA findings, and transverse colectomy with lymph node dissection was successfully performed.

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The Anatomical and Surgical Consequences of Right Colectomy for Cancer

Abstract: An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.

Cited by 39 publications

References 16 publications

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations

Preoperative Assessment of Vascular Anatomy by Multidetector Computed Tomography Before Laparoscopic Colectomy for Transverse Colon Cancer: Report of a Case

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