Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of L
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ORIGINAL ARTICLE
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 Linjie Bian 1 & Danping Wu 1 & Yigang Chen 2
&
Zhuiyang Zhang 1 & Jianming Ni 1 & Lei Zhang 1 & Jiazen Xia 2
Received: 8 July 2019 / Accepted: 29 October 2019 # 2019 The Society for Surgery of the Alimentary Tract
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 threedimensional 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. Keywords Angiography . Complete mesocolic excision . Gastrocolic trunk of Henle . Preoperative evaluation
The advantages of minimally invasive laparoscopic complete mesocolic excision (CME) for right colon cancer have been widely recognized.1, 2 However, it is difficult to achieve the * Yigang Chen [email protected] 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
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
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