Preoperative imaging of the mesenteric vasculature improves outcomes in laparoscopic complete mesocolic cancer excision

Purpose: Despite convergent evidence indicating a wide range of advantages for computed tomography angiography (CTA) for evaluating vascular anatomy prior to laparoscopic complete mesocolic excision (CME), the operative effects of CTA remain to be determined. In this study, we investigated alterations in operative outcomes caused by preoperative CTA. Methods: Based on CTA, arterial and venous vessels were reconstructed prior to laparoscopic CME (CTA group) in 84 patients with colon cancer. Sixteen of these patients were excluded from the analysis of the operative outcomes because of undergoing either laparoscopic surgery combined with resection of other organs or radiofrequency ablation. The remaining 68 patients were enrolled in the CTA group for the analysis of the operative outcomes. For comparison, 61 patients had the same surgery without preoperative CTA (Control group). Results: We found that the right colon artery (RCA) and the right colon vein (RCV) were absent in 42.9% and 23.8% of patients, respectively. Some patients, 17.9%, had one superior RCA (SRCA) and 1.1% had two SRCAs. Many patients, 40.5%, had one superior RCV (SRCV), and 2.4% had two. The gastrocolic trunk (GCT) was observed in 89.3% of patients in CTA group. Compared to the Control group, operative time declined in CTA group (181.0 vs. 159.8 mins), and the intraoperative blood loss in CTA group decreased (157.0 vs. 108.2 ml, P=0.001). Additionally, the intraoperative blood loss decreased more in laparoscopic CME for right-sided tumors, from 174.2±121.0 ml to 107.6±67.3 ml in the Control and CTA groups respectively (P<0.001). Conclusions: Preoperative CTA performed in colon cancer patients could help reduce the intraoperative blood loss during the laparoscopic CME. Preoperative CTA is a novel technique to assist surgeons in the evaluation of individual mesenteric vascular variations and could reduce the risk of vessel injury during surgery.