Preoperative simulation using 3D-CT angiography in splenic flexure colon cancer: a retrospective observational study

Abstract

Purpose: This study aimed to evaluate the extent of lymph node dissection (LND) determined using preoperative Three-dimensional computed tomography angiography (3D-CTA), in the management of splenic flexure colon cancer (SFC).Methods: In this retrospective observational study, sixty patients who underwent preoperative 3D-CTA and laparoscopic complete mesocolic excision for SFC between September 2012 and December 2021 were identified at a tertiary care center in Japan. Preoperative 3D-CTA was used to confirm the feeding arteries, following which the extent of LND was determined. Left hemicolectomy (LHC) was performed in cases requiring LND in the domains of the middle colic artery and left colic artery. In other cases, a partial colectomy (PC) that was defined as a segmental resection of the splenic flexure with LND in the domains of the feeding arterie(s) was performed. Surgical and oncological outcomes were compared between PC and LHC.Results: Preoperative 3D-CTA enabled the evaluation of the feeding artery in all patients. PC was performed in 51 patients (85.0%). Patients who underwent PC had a shorter operating time (P=0.04) and lesser blood loss (P=0.02). There was no difference in complications between the two groups. The number of harvested lymph nodes was lower in the PC group (P=0.008); however, the number of metastatic lymph nodes was comparable. There was no significant difference in the 3-year overall survival, as well as the 3-year disease free survival.Conclusions: Preoperative simulation using 3D-CTA has the potential to be useful in the identification of feeding arteries and determination of optimal extent of LND.Trial registration: The trial was registered with the UMIN Clinical Trials Registry, number UMIN000047600.