Current practice when performing right colectomy for cancer is to divide the feeding vessels for the right colon on the right side of the superior mesenteric vein.
This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics.
This study presents a retrospective review of prospective data.
The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway.
Patients with leakage after a right colectomy for cancer (2003–2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software).
Both preoperative and postoperative CTs were retrieved, reanalyzed, and 3-dimensionally reconstructed (Osirix v.3.0.2./Mimics v.13.1.). Patients without postoperative CTs were excluded.
The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein.
Eighteen patients, median age 69 (10 men) were included. All patients had postoperative CTs, and 15 patients had preoperative CTs. Median time from operation to postoperative CT was 5 days. The ileocolic artery was found in 14 (11 CT pairs) patients, and the right colic artery was found in 5 (4 pairs) patients. Actual stump lengths were 28.0 mm (SD 9.3) and 37.3 mm (SD 14.9). A significant statistical difference between presumed and actual ileocolic artery stump lengths was found (P = .002). Posterior crossing to the superior mesenteric vein was noticed in 8 of 14 ileocolic arteries and in 3 of 5 right colic arteries. There was no statistical difference in mean caliber for the preoperative and postoperative right colic artery (P = .505) and ileocolic artery (P = .474).
Difficulties when interpreting the postoperative images, due to intra-abdominal effusion, staples, edema, and altered syntopy of blood vessels, were overcome through comparison with preoperative CTs.
An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.
1 Department of Gastrointestinal Surgery, Vestfold Hospital, Tonsberg, Norway
2 Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
3 Interventional Centre, Gastrointestinal and Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
4 Akershus University Hospital, University of Oslo, Department of Digestive Surgery, Oslo, Norway
Funding/Support: This work was supported by the Vestfold Hospital Trust.
Financial Disclosures: None reported.
Presented at the meeting of the Norwegian Surgical Society, Oslo, Norway, October 25 to 29, 2010.
Correspondence: D. Ignjatovic, M.D., Ph.D., Department of Gastrointestinal Surgery, Vestfold Hospital, Post Box 2168, 3103 Tonsberg, Norway. E-mail: firstname.lastname@example.org