BACKGROUND: 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.
OBJECTIVE: This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics.
DESIGN: This study presents a retrospective review of prospective data.
SETTINGS: The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway.
PATIENTS: Patients with leakage after a right colectomy for cancer (2003–2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software).
INTERVENTIONS: 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.
MAIN OUTCOME MEASURES: The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein.
RESULTS: 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).
LIMITATIONS: 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.
CONCLUSION: 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