Right-sided Colon Cancer
Conditions
Keywords
Right colon cancer, complete mesocolic excision, CT abdominal scan
Brief summary
Colorectal surgery has made progressive advances in recent years related on one hand to the implementation of diagnostic methods that allow an early diagnosis of tumors and on the other hand to the development of therapeutic options based on laparoscopic surgery. In particular, multicenter clinical trials have shown that the laparoscopic approach to colorectal cancer had a comparable or even better outcomes in terms of perioperative complications and functional recovery of patients than traditional surgery. Complete Mesocolic Excision (CME) in right colonic resections is a surgical approach, of greater technical complexity, that appears to improve the oncological outcomes of these patients at the cost of an increased rate of complications. The highest rate of complications reported in the literature in patients undergoing CME was related to intraoperative bleeding due to the central vascular dissection that is performed. CT technological advances have made possible to perform CT angiography with multiplanar and three-dimensional reconstructions with the possibility of obtaining a detailed preoperative map of the vascular anatomy of these patients. CT scan was acquired immediately before contrast material injection and during arterial and venous phase. Arterial phase was obtained using the bolus tracking technique with an automated scan-triggering software. Image analysis was performed using multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D volume rendering (VR) technique. The purpose of the CT was to identify three different parameters necessary for proper performance of CME and CVL and to compare preoperative observations with intraoperative evidence. All surgeries were performed by teams experienced in laparoscopic colorectal surgery. The investigators evaluated:- Fascia of Fredet; vascular structures; lymph nodes.
Detailed description
x
Interventions
PROCEDURELaparoscopic right colonic resection with Complete Mesocolic Excision (CME)
RADIATION3D CT angiography
Sponsors
University of Palermo
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* patients with diagnosis of right-sided colon cancer * patients underwent to CT angiography * laparoscopic right hemicolectomy with CME and CVL.
Exclusion criteria
* metastatic disease * palliative treatment * impossibility to perform CT angiography * patients underwent to a traditional colonic resection with D2 lymphadenectomy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Preoperative radiologic assessment of patients with diagnosis of right-sided colon cancer. The investigators evaluated: fascia of Fredet; vascular structures (ileocolic vessels; right colic artery, middle colic artery, trunk of Henle); lymph nodes. | Evaluation of preoperative CT scan features during enrollment of patients. | Evaluation of preoperative CT scan features during enrollment of patients. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative outcomes: intraoperative complications | intraoperative time | complication occurred during surgery |
| Perioperative outcomes: postoperative complications | up to 30 days postoperative | complication occurred in postoperative period |
| Perioperative outcomes: mean operative time | intraoperative time | operative time |
| perioperative outcomes: rate of conversion | intraoperative time | rate of conversion from laparoscopy to open surgery |
Countries
Italy
Contacts
Primary ContactAntonino Agrusa, Professor
Outcome results
None listed