Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

doi:10.4251/wjgo.v11.i3.208

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Oncol. Mar 15, 2019; 11(3): 208-226
Published online Mar 15, 2019. doi: 10.4251/wjgo.v11.i3.208

Table 1 Patient demographics

Characteristic	Group A	Group B
Age (yr)
Mean	64	59
Range	49-80	40-76
Sex
Male	14	16
Female	15	13
Type of colectomy
Right colectomy	12	10
Left-sided colectomies	17	19
Left colectomy	4	16
Sigmoidectomy	13	3
pT stage
pTis	1	3
pT2	3	17
pT3	19	9
pT4	6
pN stage
pNx	1
pN0	13	14
pN1	11	9
pN2	4	6
M stage
M0	29	29
M1	0	0

Table 2 Comparison of arterial stump length between the three observers

Observer	n	Median length, mm	IQR, mm	χ²	¹P-value
Livadaru C	58	35.70	21.38-60.30	0.01	0.999
1^st Radiologist	58	34.00	21.50-61.63
2^nd Radiologist	58	35.00	20.98-62.50

¹Reference to RESULTS text. IQR: Interquartile range.

Table 3 All colectomies: Comparison between groups A and B

	Group A, median (mean) in mm, (IQR)	Group B, median (mean) in mm, (IQR)	A – B difference, mean in mm ± SD, (95%CI)	Statistics for A – B difference¹	P-value
All colectomies, n	29	29	-	-	-
Actual stump	22.63 (25.60), (20.16-31.04)	61.80 (61.27), (45.07-69.87)	-35.66 ±30.83, (21.24-62.26)	χ² = 27.38, η² = 0.47	< 0.001²
D₂PLL	26.00 (25.34), (20.15-30.53)	34.00 (29.13), (11.00-41.10)	-3.79 ±13.98, (-11.90–4.32)	t = -0.936, df = 56	0.353
D₂IP, mean ± SD	0.26 ± 12.18	32.14 ± 26.15	-31.88 ± 26.52, (-41.96-21.79)	χ² = 22.13, η² = 0.38	< 0.001²
Statistics for D₂IP, χ² (df), P	0.005 (1), 0.944	21.77 (1), < 0.001	-	-	-

¹χ² = Kruskal-Wallis test; η² = effect size estimate; t = t-test.

²Reference to RESULTS text. D₂IP: D2 improvement potential, calculated as difference of actual stump; D₂PLL: D2 predicted ligation level; IQR: Interquartile range.

Table 4 Right colectomies: Ileocolic artery stump comparison between groups A and B

	Group A, mean in mm ± SD, (95%CI)	Group B, mean in mm ± SD, (95%CI)	A – B difference, mean in mm ± SE, (95%CI)	Statistics for A – B difference, t (df)¹	P-value
Right colectomies, n	12	10	-	-	-
Actual stump	16.97 ± 4.77, (13.94-19.96)	49.93 ± 20.29, (35.40-64.44)	-32.96 ± 6.53, [-47.62-(-18.30)]	-5.02 (9.83)	0.001²
D₂PLL	11.12 ± 2.97, (9.23-13.00)	7.80 ± 6.53, (3.13-12.47)	3.32 ± 2.10, (-1.06-7.69)	1.58 (20)	0.130
D₂IP	5.85 ± 4.71, (2.85-8.84)	42.13 ± 21.50, (26.75-57.50)	-35.78 ± 6.74, [-50.83-(-20.72)]	-5.31 (9.77)	< 0.001²
Statistics for D₂IP, t (df), P	4.30 (11), 0.001²	6.20 (9), < 0.001²	-	-	-

¹t-test.

²Reference to RESULTS text. D₂IP: D2 improvement potential, calculated as difference of actual stump; D₂PLL: D2 predicted ligation level.

Table 5 Sigmoidectomies: Inferior mesenteric artery stump comparison between groups A and B

	Group A, mean in mm ± SD, (95%CI)	Group B, mean in mm ± SD, (95%CI)	A – B difference, mean in mm ± SE, (95%CI)	Statistics for A – B difference, t (df)	P-value
Sigmoidectomies, n	13	16	-	-	-
Actual stump	35.42 ± 1 5.62, (25.98-44.86)	69.92 ± 30.29, (53.78-86.06)	-34.50 ± 9.28, [-53.55-(-15.45)]	-3.72 (27)	< 0.001¹
D₂PLL	35.15 ± 8.85, (29.80-40.50)	40.08 ± 8.36, (35.62-44.53)	-4.93 ± 3.20, (-11.50-1.65)	-1.54 (27)	0.136
D₂IP	0.27 ± 12.90, [-7.53-(-8.06)]	29.84 ± 29.67, (14.56-45.12)	-29.57 ± 8.01, [-46.20-(-12.94)]	-3.69 (21.72)	0.001¹
D₃IP	25.42 ± 15.62, (15.98-34.86)	59.92 ± 30.29, (43.78-76.06)	-34.50 ± 9.28, [-53.55-(-15.45)]	-3.72 (27)	< 0.001¹
Statistics for D₂IP, t (df), P	0.07 (12), 0.942¹	4.16 (15), < 0.01¹	-	-	-
Statistics for D₃IP, t (df), P	5.87 (12), 0.001¹	7.91 (15), < 0.01¹	-	-	-

¹Reference to RESULTS text. D₂IP: D2 improvement potential, calculated as difference of actual stump - D₂PLL; D₃IP improvement potential, calculated as difference of actual stump – 10 mm (D3 level). D₂PLL: D2 predicted ligation level.

Table 6 Left colectomies: Inferior mesenteric artery stump comparison between groups A and B

	Group A, mean in mm ± SD, (95%CI)	Group B, mean in mm ± SD, (95%CI)	A – B difference, mean in mm ± SE, (95%CI)	Statistics for A – B difference, t (df)	P-value
Left colectomy, n	4	3	-	-	-
Actual stump	19.60 ± 9.22, (4.94-34.27)	52.93 ± 13.15, (20.27-85.60)	-33.33 ± 8.37, [-54.85-(-11.81)]	-3.98 (5)	0.011¹
D₂PLL	36.12 ± 3.52, (30.52-41.73)	40.17 ± 8.25, (19.67-60.66)	-4.04 ±4.50, (-15.60-7.52)	-0.90 (5)	0.410
D₂IP	-16.52 ± 11.71, (-35.16-2.12)	12.77 ± 19.79, [-36.40-(-61.93)]	-29.29 ± 11.8, [-59.64-(-1.06)]	-2.48 (5)	0.056
D₃IP	9.60 ± 9.21, (-5.06-24.27)	42.93 ± 13.15, (10.27-75.60)	-33.33 ± 8.37, [-54.85-(-11.81)]	-3.98 (5)	0.011¹
Statistics for D₂IP, t (df), P	-2.82 (3), 0.067¹	1.12 (2), 0.38	-	-	-
Statistics for D₃IP, t (df), P	2.08 (3), 0.129¹	5.66 (2), 0.03¹	-	-	-

¹Reference to RESULTS text. D₂IP: D2 improvement potential, calculated as difference of actual stump; D₃IP improvement potential, calculated as difference of actual stump – 10 mm (D3 level). D₂PLL: D2 predicted ligation level.

Table 7 Left colectomies and sigmoidectomies: Overview of all the inferior mesenteric artery stumps between groups A and B

	Group A, mean in mm ± SD, (95%CI)	Group B, mean in mm ± SD, (95%CI)	A – B difference, mean in mm ± SE, (95%CI)	Statistics for A – B difference, t (df)	P-value
Left colectomy, n	17	19	-	-	-
Actual stump	31.70 ± 15.71, (23.62-39.77)	67.24 ± 28.71, (53.40-81.07)	-35.54 ± 7.85, [-51.48-(-19.59)]	-4.53 (34)	< 0.001
D₂PLL	35.38 ± 7.83, (31.36-39.41)	40.09 ± 8.11, (36.18-44.00)	-4.71 ± 2.66, (-10.13-0.70)	-1.77 (34)	0.086
D₂IP	-3.68 ± 14.30, (-11.04-3.67)	27.14 ± 27.74, (13.77-40.51)	-30.83 ± 7.25, [-45.68-(-15.97)]	-4.25 (27.5)	< 0.001
D₃IP	21.70 ± 15.71, (13.62-29.78)	57.24 ± 28.71, (43.40-71.07)	-35.54 ± 7.85, [-51.48-(-19.59)]	-4.53 (34)	< 0.001
Statistics for D₂IP, t (df), P	-1.06 (16), ^l0.304	4.26 (18), < 0.01¹	-	-	-
Statistics for D₃IP, t (df), P	5.69 (16), < 0.001	8.68 (18), < 0.001	-	-	-

Table 8 Group A: Correlation of lymph node count and specimen length with stump length

	n	Mean (median)	SD	IQR	*r_s*	P-value
LN count	29	34.83 (36.00)	16.75	(20.50-43.00)	-0.40	0.032¹
Specimen length in cm	29	26.26 (23.00)	9.90	(18.00-34.00)	-0.44	0.016¹

¹Reference to RESULTS text. IQR: Interquartile range; LN: Lymph node.

Table 9 Computed tomography evaluated ileocolic artery stumps in the literature

Study, year	n	Actual ileocolic stump in mm	Presumed D2 ileocolic stump in mm
Group A - our study, 2018, mean ± SD (95%CI)	12	17.69 ± 4.77 (13.94-19.96)	11.12 ± 2.97 (9.23-13.00)
Munkedal et al[22] 2017, mean (95%CI)	32	31.0 (25-37)	10.0¹
Kaye et al[26] 2015, mean, (range)	128	28.1 (2.5–74.3)	14.4 (6.4)
Spasojevic et al[25] 2011, mean ± SD	11	28.0 ± 9.3	18.1 ± 4.0

¹Chosen as reference value from the complete mesocolic excision guideline[2,21].

Table 10 Computed tomography evaluated inferior mesenteric artery stumps in the literature

Study, year	n	Actual IMA stump in mm	Presumed IMA stump in mm
Group A from our study, mean ± SD (95%CI)	17	31.70 ± 15.6 (26.0-44.9)	35.38 ± 7.83 (31.36-39.41)
Munkedal et al[22] 2017, mean (95%CI)	20	49.0 (40-57)	35.0
Prevot et al[42] 2013, mean (range)	26	30.3 (0.3–60)	-

IMA: Inferior mesenteric artery.

Citation: Livadaru C, Morarasu S, Frunza TC, Ghitun FA, Paiu-Spiridon EF, Sava F, Terinte C, Ferariu D, Lunca S, Dimofte GM. Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision. World J Gastrointest Oncol 2019; 11(3): 208-226
URL: https://www.wjgnet.com/1948-5204/full/v11/i3/208.htm
DOI: https://dx.doi.org/10.4251/wjgo.v11.i3.208