Can preoperative CT angiography and three-dimensional reconstruction of the mesenteric artery of the colon improve laparoscopic colectomy and postoperative rehabilitation in patients with colon cancer? A pilot randomized control study.

Abstract

Purpose: To assess the effect of computed tomography angiography (CTA) and three-dimensional (3D) reconstruction on laparoscopic colectomy in patients with colon cancer.

Methods: Patients with colon cancer who were treated at Zhejiang Cancer Hospital between August 2020 and December 2022 were included in this pilot, randomized controlled trial. The participants were randomly assigned to either the CTA group, in which patients underwent preoperative CTA and 3D reconstruction, or the control group, in which patients underwent preoperative enhanced abdominal and pelvic CT examinations. The primary outcome was the duration of the operation. The secondary outcomes included intraoperative blood loss, length of hospital stay, number of lymph node dissections, fasting duration, duration of tube drainage, overall survival (OS), and progression-free survival (PFS). To minimize statistical bias, patients were stratified into subgroups on the basis of tumor location (left colon or right colon). Additionally, variations in the middle colonic artery (MCA), inferior mesenteric artery (IMA), and colonic branches of superior mesenteric artery (cbSMA) classifications were documented.

Results: A total of 82 patients (41 in each group) were included in the analysis. The CTA group had significantly shorter operation durations (123.68 ± 26.09 vs. 154.12 ± 33.15 min, P < 0.001) and fasting durations (median 4.00 vs. 5.00 days, P < 0.001) as well as reduced intraoperative blood loss (median 50.00 vs. 100.00 mL, P = 0.001) compared to the control group; these differences were observed in the overall colon cancer cohort and in the left and right colon subgroups. However, no significant differences were observed between the two groups in terms of lymph node dissection, tube drainage duration, hospitalization duration, OS or PFS. In the CTA group, the proportions of patients with different IMA types were as follows: Type A (60.97%), Type B (9.76%), Type C (17.07%), and Type D (12.20%); the proportions of patients with different MCA types were as follows: Type A (78.05%), Type B (12.20%), Type C (7.31%), and Type D (2.44%); and the proportions of patients with different cbSMA types were as follows: Type A (65.85%), Type B (7.32%), Type C (17.07%), and Type D (9.76%). Patients with a tumor size ≥ 5 cm, preoperative intestinal obstruction, postoperative pathological serosal invasion, lymph node metastasis, and stage III disease had significantly worse OS and PFS than those with a tumor size < 5 cm (P = 0.007, P = 0.026), no preoperative intestinal obstruction (P = 0.015, P = 0.019), no serosal invasion (P = 0.001, P = 0.001), no lymph node metastasis (P = 0.016, P = 0.001), and stage I-II disease (P = 0.013, P = 0.001). However, no significant differences in OS or PFS were observed between patients who underwent preoperative CTA examination and the control group (P = 0.551, P = 0.591), between male and female patients (P = 0.402, P = 0.361), or between patients with and without postoperative complications (P = 0.561, P = 0.520). Finally, multivariate Cox proportional hazards regression analysis revealed that serosal invasion (P = 0.013; P = 0.009), lymph node metastasis (P = 0.029; P = 0.043), and tumor stage (P = 0.002; P = 0.001) were independent prognostic factors that affected the OS and PFS of patients with colon cancer.

Conclusion: Preoperative CTA and 3D reconstruction provide essential information for laparoscopic surgery, facilitate the optimization of surgical procedures, and support improved postoperative recovery for patients with colon cancer, suggesting promising clinical applications.