Personalized 3D-modeling of the arterial bloodstream for performing vascular-oriented extended lymph node dissection for colorectal cancer

Introduction. In the surgical treatment of colorectal cancer, lymph node dissection is very important.

Study Objective. To determine the advantages of personalized 3D-modeling of mesenteric vessels for performing vascular-oriented extended lymph node dissection in the treatment of colorectal cancer.

Materials and methods. The patients with verified adenocarcinoma of colon or rectum underwent the construction of 3D-models of mesenteric vascular bloodstream. At the preoperative stage, the types of the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) were evaluated. The operative time and the number of harvested lymph nodes were compared between the groups with and without 3D-CT.

Results. A total of 146 patients with colorectal cancer were included in the study. E1-type of the IMA was found in 28 (41,1 %) patients, E2 in 3 (4,4 %), E3 in 6 (8,8 %), K-type in 11 (16,2 %), and H-type in 20 (29,5 %). For SMA, the presence of the right colic artery was detected in 5 (22,7 %) cases. The middle colic artery was absent in one patient (5,5 %). The average duration of surgery did not differ significantly between the groups with and without 3D-CT. The number of harvested lymph nodes was higher in the groups with 3D-CT (26±13 and 19±7, p value = 0.00139 for left-sided cancer, and 41±26 and 17±5, p value <0.00001 for right-sided cancer).

Conclusion. Routine examination of 3D-reconstructions allows preoperative determination of vessel’s structure in the lymph node dissection zone, which improves intraoperative navigation.

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