Munkedal, DLE, Rosenkilde, M, Nielsen, DT et al. (3 more authors) (2017) Radiological and pathological evaluation of the level of arterial division after colon cancer surgery. Colorectal Disease, 19 (7). O238-O245. ISSN 1462-8910
Abstract
Aim In aiming to cure patients with colorectal cancer surgery, the surgeon must carefully dissect the mesocolon and mesorectum and divide the vascular pedicle near to its origin so as to include all local lymph nodes. This has been termed complete mesocolic excision. The distance from the distal vascular tie to the bowel wall in the fixed specimen is an indication as to the quality of surgery but this does not assess the length of the residual vascular pedicle and, by implication, residual lymph nodes. The aim of this study was to establish if our surgeons were carrying out complete mesocolic excision by assessing the length of the proximal arterial pedicle and relating this to arterial length in the fixed specimen. Method This was a single centre prospective study of patients undergoing elective surgery for locally advanced colorectal cancer. An abdominal and pelvic CT scan was performed 2 days postoperatively and a radiologist blinded to the operative procedure measured the length of the residual arterial stump. Similarly, the length of the vessel in the fixed resected specimen and lymph node yield were also recorded. Results Fifty-two patients were recruited. The mean length of the residual arterial stump was 38 mm (95% CI: 33–43), which was significantly longer than the < 10 mm recommended in guidelines (P < 0.0001). The mean length was 31 mm (95% CI: 25–37) and 49 mm (95% CI: 40–57) for left and right sided resections respectively. There was no correlation between the residual arterial stump and the pathology. Conclusions The residual arterial length was greater than suggested by guidelines and may indicate that our surgery is less radical than we planned. Caution should be taken when using pathological measurements of vascular ligation as it may not reflect the height of the pedicle division.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 The Association of Coloproctology of Great Britain and Ireland. This is the peer reviewed version of the following article: [Munkedal, D. L. E., Rosenkilde, M., Nielsen, D. T., Sommer, T., West, N. P. and Laurberg, S. (2017), Radiological and pathological evaluation of the level of arterial division after colon cancer surgery. Colorectal Dis, 19: O238–O245], which has been published in final form at http://doi.org/10.1111/codi.13756. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. |
Keywords: | Complete mesocolic excision; central division; colon cancer sugery; radiology |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cancer and Pathology (LICAP) > Pathology & Tumour Biology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 11 Apr 2017 10:54 |
Last Modified: | 08 Jun 2018 00:38 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/codi.13756 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:114945 |