K Naidu, P Chapuis, J Yang, S Koneru, C Chan, M Rickard, K-S Ng
{"title":"计算机断层扫描评估结直肠癌手术后残余动脉蒂长度是评估手术质量的有用指标吗？","authors":"K Naidu, P Chapuis, J Yang, S Koneru, C Chan, M Rickard, K-S Ng","doi":"10.1007/s10151-025-03130-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In vivo residual arterial pedicle length (RAPL) has been proposed as a quality indicator for central vascular ligation (CVL [i.e., RAPL ≤ 10 mm]) in colorectal cancer (CRC) surgery. However, its survival association in non-routine CVL practice requires clarification. This study aimed to assess the feasibility and reproducibility of measuring RAPL alongside its oncological associations in non-routine CVL surgery.</p><p><strong>Methods: </strong>A prospective cohort study at Concord Hospital was conducted on anterior resection (AR) or right hemicolectomy (RH) patients with stage I to III CRC (1995-2019). Using surveillance computed tomography (CT), RAPL of the inferior mesenteric artery (IMA) or ileo-colic artery (ICA) pedicle was measured independently by two observers. The intra-class correlation coefficient assessed the reproducibility of the measurements. Kaplan-Meier and univariate Cox regression analyses estimated overall survival (OS) and disease-free survival (DFS), while univariate and multivariate linear regression models tested correlations between RAPL and clinicopathological features.</p><p><strong>Results: </strong>A total of 1425 patients underwent a CRC operation. Post-operative CTs were reviewed in 424 patients, with 422 (mean age 69.0 years [SD 12.3]; 54.0% males) RAPLs measured. The majority studied underwent an AR (59.2%). Excellent inter-rater reliability was noted in AR (ICC = 0.97; P < 0.001) and RH (ICC = 0.89; P < 0.001) patients. No association was observed between RAPL and OS or DFS in either group. Also, RAPL lacked association with nodal harvest in either AR (P = 0.54) or RH (P = 0.16) patients.</p><p><strong>Conclusion: </strong>The value of RAPL as a quality marker of CRC surgery in non-routine CVL practice has not been confirmed. Furthermore, its lack of association with nodal harvest emphasizes the importance and the need for comprehensive pathology examination of the specimen following resection of CRC.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"101"},"PeriodicalIF":2.9000,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993473/pdf/","citationCount":"0","resultStr":"{\"title\":\"Is computed tomography assessment of residual arterial pedicle length following colorectal cancer surgery a useful marker of surgical quality?\",\"authors\":\"K Naidu, P Chapuis, J Yang, S Koneru, C Chan, M Rickard, K-S Ng\",\"doi\":\"10.1007/s10151-025-03130-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In vivo residual arterial pedicle length (RAPL) has been proposed as a quality indicator for central vascular ligation (CVL [i.e., RAPL ≤ 10 mm]) in colorectal cancer (CRC) surgery. However, its survival association in non-routine CVL practice requires clarification. This study aimed to assess the feasibility and reproducibility of measuring RAPL alongside its oncological associations in non-routine CVL surgery.</p><p><strong>Methods: </strong>A prospective cohort study at Concord Hospital was conducted on anterior resection (AR) or right hemicolectomy (RH) patients with stage I to III CRC (1995-2019). Using surveillance computed tomography (CT), RAPL of the inferior mesenteric artery (IMA) or ileo-colic artery (ICA) pedicle was measured independently by two observers. The intra-class correlation coefficient assessed the reproducibility of the measurements. Kaplan-Meier and univariate Cox regression analyses estimated overall survival (OS) and disease-free survival (DFS), while univariate and multivariate linear regression models tested correlations between RAPL and clinicopathological features.</p><p><strong>Results: </strong>A total of 1425 patients underwent a CRC operation. Post-operative CTs were reviewed in 424 patients, with 422 (mean age 69.0 years [SD 12.3]; 54.0% males) RAPLs measured. The majority studied underwent an AR (59.2%). Excellent inter-rater reliability was noted in AR (ICC = 0.97; P < 0.001) and RH (ICC = 0.89; P < 0.001) patients. No association was observed between RAPL and OS or DFS in either group. Also, RAPL lacked association with nodal harvest in either AR (P = 0.54) or RH (P = 0.16) patients.</p><p><strong>Conclusion: </strong>The value of RAPL as a quality marker of CRC surgery in non-routine CVL practice has not been confirmed. Furthermore, its lack of association with nodal harvest emphasizes the importance and the need for comprehensive pathology examination of the specimen following resection of CRC.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"101\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-04-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993473/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-025-03130-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03130-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Is computed tomography assessment of residual arterial pedicle length following colorectal cancer surgery a useful marker of surgical quality?
Background: In vivo residual arterial pedicle length (RAPL) has been proposed as a quality indicator for central vascular ligation (CVL [i.e., RAPL ≤ 10 mm]) in colorectal cancer (CRC) surgery. However, its survival association in non-routine CVL practice requires clarification. This study aimed to assess the feasibility and reproducibility of measuring RAPL alongside its oncological associations in non-routine CVL surgery.
Methods: A prospective cohort study at Concord Hospital was conducted on anterior resection (AR) or right hemicolectomy (RH) patients with stage I to III CRC (1995-2019). Using surveillance computed tomography (CT), RAPL of the inferior mesenteric artery (IMA) or ileo-colic artery (ICA) pedicle was measured independently by two observers. The intra-class correlation coefficient assessed the reproducibility of the measurements. Kaplan-Meier and univariate Cox regression analyses estimated overall survival (OS) and disease-free survival (DFS), while univariate and multivariate linear regression models tested correlations between RAPL and clinicopathological features.
Results: A total of 1425 patients underwent a CRC operation. Post-operative CTs were reviewed in 424 patients, with 422 (mean age 69.0 years [SD 12.3]; 54.0% males) RAPLs measured. The majority studied underwent an AR (59.2%). Excellent inter-rater reliability was noted in AR (ICC = 0.97; P < 0.001) and RH (ICC = 0.89; P < 0.001) patients. No association was observed between RAPL and OS or DFS in either group. Also, RAPL lacked association with nodal harvest in either AR (P = 0.54) or RH (P = 0.16) patients.
Conclusion: The value of RAPL as a quality marker of CRC surgery in non-routine CVL practice has not been confirmed. Furthermore, its lack of association with nodal harvest emphasizes the importance and the need for comprehensive pathology examination of the specimen following resection of CRC.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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