Patient-specific 3D vascular reconstructions improve preoperative planning for right colectomy with complete mesocolic excision: A crossover study.

Abstract

Introduction: Complete mesocolic excision (CME) for right-sided colon cancer is technically demanding due to substantial variability in mesenteric vascular anatomy. Patient-specific three-dimensional (3D) vascular reconstructions may improve preoperative planning by enhancing the accuracy and efficiency of anatomical analysis. This study assessed the impact of 3D reconstructions on anatomical accuracy and interpretation time compared with conventional CT.

Materials and methods: This retrospective, single-centre comparative study used a cross-over design. Portal-venous phase CT scans were analysed using either conventional CT interpretation or patient-specific 3D vascular reconstructions (Visible Patient®, Strasbourg, France). Readers with different levels of experience assessed right colonic arterial and venous anatomy. Anatomical accuracy and interpretation time were compared using mixed-effects models accounting for reader- and patient-related effects.

Results: Thirty patients and fourteen readers (seven junior and seven senior) were included, yielding 840 imaging assessments. Anatomical accuracy was significantly higher with 3D reconstructions (adjusted OR 2.05, 95% CI 1.76-2.40; P<0.001), independently of reader experience and reading sequence. Median interpretation time was significantly shorter with 3D reconstructions compared with conventional CT (150 s [110-232] vs. 335 s [203-500], P<0.0001). In multivariable analysis, 3D reconstructions remained independently associated with reduced interpretation time, with a stronger effect in junior (-60%) than senior readers (-35%).

Conclusion: Patient-specific 3D vascular reconstructions improve both the accuracy and efficiency of preoperative anatomical assessment for right-sided colon surgery compared with conventional CT interpretation. These findings support their integration into preoperative planning for CME, with potential benefits for surgical standardisation and training.