Preoperative anatomical road mapping reduces variability of operating time, estimated blood loss, and lymph node yield in right colectomy with extended D3 mesenterectomy for cancer

Abstract

Objective: To assess the impact of individual patient anatomy on operating time, estimated blood loss (EBL), and lymph node yield in right colectomy with extended D3 mesenterectomy, where surgeons have access to a preoperative 3-D reconstruction of the vascular anatomy of patients before surgery. Data on the impact of individual patient vascular anatomy when surgeons have an anatomical road map as a guide at surgery is still missing in the literature.

Method: Consecutive patients enrolled in an ongoing trial were classified into 4 groups and 2 subgroups using a 3-D vascular anatomy reconstruction derived from the staging CT. Outcome measures are operating time, EBL, vascular events, and D3 volume lymph node yield. SPSS was used for statistical analysis.

Results: One hundred seventy-six (77 men) patients included. Mean operating time was 200 ± 50 min. Type 4b required significantly longer operating time (mean, 219 ± 59) compared to type 3 (mean, 188 ± 43) (p = 0.004). Vascular events occurred most often in anatomy type 4b (20.0%) and 3 (19.2%). No difference in EBL and lymph node yield was found (p = 0.102 and p = 0.803, respectively).

Conclusion: The use of a roadmap at surgery seems to even differences in operating time, EBL, and lymph node yield, independent of the complexity of the individual patient's central mesenteric vascular anatomy. The incidents of vascular events requiring hemostasis do not cause differences in EBL between the anatomy groups, suggesting that preoperative awareness of the anatomy is beneficial at surgery.

Keywords: 3D vascular anatomy; Colon cancer; Estimated Blood Loss; Lymph node yield; Operating time; Right colectomy; Surgical roadmapping.