Routine CT evaluation of central vascular ligation in patients undergoing complete mesocolic excision for sigmoid colon cancer

Abstract

Colorectal cancer is the second most diagnosed cancer worldwide with an annual incidence of 1.7 million [1,2], of which approximately two-thirds occur in the colon. Surgery is considered the primary treatment for colon cancer, achieving good long-term oncological outcomes for patients [3]. The adoption of a standardized surgical approach according to principles of complete mesocolic excision (CME) with complete tumour removal has been linked with improved specimen quality. The technique follows strict dissection principles along the embryological planes of the mesocolon [4,5] with central vascular ligation (CVL) of the main tumour-feeding arteries [6][7][8] for adequate clearance of micrometastasis and lymph nodes of the

Quality assessment of surgery for colorectal cancer: Where do we stand?

“…The CME group uses the distance from tie to tumor measured on fresh specimens as an indicator of CVL, and this is by any means adequate if reported by pathologists, which in real world practice is not the case. But there is a way of quantifying the CVL retrospectively without using the specimen and that is by measuring the central vessel stumps on postoperative computed tomography scans, which are performed as part of a routine cancer follow-up[ 17 - 20 ]. The inferior mesenteric artery stump on the left and ileocolic artery (even middle colic artery in transverse colon cancers) stumps on the right can be measured with replicability both by radiologists and clinicians with minimal training.…”

Complete mesocolic excision for colon cancer: current status and controversies

“…These indicators are important academically, and are used to ensure high quality surgery in studies of CME with CVL/D3 12,13 . Computed tomography has also been used to assess the length of residual arterial stump postoperatively 33,34 . It is noteworthy that in one study, despite CME being performed by trained colorectal surgeons, the mean postoperative length of the residual ileocolic or inferior mesenteric arterial stump was 38 mm 21 …”