CT assessment of right colonic arterial anatomy pre and post cancer resection - a potential marker for quality and extent of surgery?
BACKGROUND
There is conflicting opinion as to the optimum extent of resection for right-sided colonic cancer, which is currently graded by pathological analysis of the resected specimen. It is not known if computed tomography (CT) analysis of residual post-resection arterial stump length could be used as an alternative in vivo marker for extent of mesenteric resection. Ileocolic artery stumps have been demonstrated previously on CT after right hemicolectomy, but only in the early postoperative period.


OBJECTIVE
To analyze preoperative right colonic arterial anatomy using portal venous colorectal cancer staging CT and subsequently determine if post-resection arterial stumps (a potential in vivo marker of surgical resection) could be consistently identified using routine follow-up CT scans many months after cancer resection.


METHODS
A retrospective analysis of routine staging and follow-up CT scans for 151 patients with right-sided colorectal cancer was performed. Preoperative right colonic arterial anatomy and postoperative arterial stumps were analyzed and measured.


RESULTS
Preoperative ileocolic (98.8%), middle (94.7%), and right colic artery (23.8%) identification was comparable to catheter angiogram studies. Postoperative ileocolic stumps were consistently demonstrated (88.3%) many months (average, 2 years and 42 days) after resection and were significantly longer than expected for a standard D2 resection (paired t-test, t(127) = -11.45, P ≤ 0.001).


CONCLUSIONS
This is the first study to successfully demonstrate ileocolic arterial stumps many months (and years) after cancer resection using routine portal venous CT. Further prospective research should assess whether arterial stumps can be used as an in vivo marker of surgical quality and extent.
Department of Clinical Radiology and Department of Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK thomas.kaye@nhs.net.
Tom L
TL
Kaye
Department of Clinical Radiology and Department of Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Nick P
NP
West
Department of Clinical Radiology and Department of Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
David G
DG
Jayne
Department of Clinical Radiology and Department of Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Damian J M
DJ
Tolan
D003106:Colon / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D003110:Colonic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D010865:Pilot Projects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
Abdomen/GI; arteries; computed tomography (CT); large bowel; primary neoplasms; quantitative; surgery