Principled Personalised Operative Strategy using 3D Virtual Modelling Ahead of Complete Mesocolic Excision with Central Vascular Ligation for Proximal Colon Cancer.

Abstract

Purpose Here we report the usefulness of 3D virtual modelling (3DVM) for surgical planning before complete mesocolic excision (CME) and central vascular ligation (CVL) for proximal colon cancer including direct comparison to operative course and intraoperative perfusion assessment by near infrared fluorescence angiography (NIFA). Methods 26 patients underwent CT mesenteric angiogram with subsequent 3DVM (VisiblePatient©) in advance of undergoing laparoscopic right or extended-right hemicolectomy with CMECVL. 3DVM were studied by the surgical team in advance of each case and their planned operative strategy recorded. Operative notes and findings were reviewed to determine deviations from this strategy and physiological measures of perfusion at the prepared transection levels. Results Operative plans were made in every case based on tumour location (caecal versus non-caecal location) and patient 3DVM vascular anatomy and were followed without significant deviation in every case (NIFA supported the predicted transection level in all). 22 patients had complete operative notes available for comparative analysis. All patients had MA confluence with the inferior mesenteric artery territory on 3DVM and eight had independent RCAs. 12 patients had truncal MCA ligation with the left branch and indeed the entire MCA being preserved in 8 and 1 respectively (one patient with previous surgery had no MCA). Side to side ileocolic anastomosis was made with the distal transverse colon in 20 cases and with the descending colon in 2. There were no anastomotic complications postoperatively. Conclusion 3DVM can efficiently enable accurate personalized planning ahead of CME-CVL including indicating anastomotic perfusion sufficiency by vascular anatomy.