Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

Figure 1 Representative cases of stump length measurement. A: Actual ICA stump after a group A right colectomy. The lengths measured on contrast-enhanced CT were 21.5 mm – actual length with granuloma (red line), 13.0 mm – D2 predicted ligation level (green line), and 8.5 mm – D2 improvement potential (blue line); B: Actual IMA stump after a group A sigmoidectomy. The lengths measured on contrast-enhanced CT were 36.0 mm – actual length with granuloma (red line), 30.5 mm – D2 predicted ligation level (green line), and 5.50 mm – D2 improvement potential (blue line); C: Reconstruction in 3D form, showing the actual inferior mesenteric artery stump after a group A high ligation. The measurements on contrast-enhanced CT were 13.0 mm – actual length (red line), 10.0 mm – D3 predicted ligation level (green line), and 3.0 mm – D3 improvement potential (blue line). The scale bar illustrates the size of 1 cm. CT: Computed tomography; ICA: Ileocolic artery; IMA: Inferior mesenteric artery.

Figure 2 Flow diagram of eligibility. CT: Computed tomography; PACS: Picture Archiving and communication system.

Figure 3 Comparison of arterial stump lengths between the three observers. CL: Cristian livadaru; EFPS: Elena florina paiu-spiridon; FS: Florina sava.

Figure 4 Comparison of all the actual stumps between groups with horizontal reference to D2 predicted ligation levels. D₂PLL: D2 predicted ligation level.

Figure 5 Comparison of ileocolic artery actual stump from right colectomies between groups, with horizontal reference to D2 predicted ligation levels. D₂PLL: D2 predicted ligation level; ICA: Ileocolic artery.

Figure 6 Comparison of inferior mesenteric artery actual stumps from sigmoidectomies between groups, with horizontal reference to D2 predicted ligation levels and D2 predicted ligation levels. D₂PLL: D2 predicted ligation level; D₃PLL: D3 predicted ligation level; IMA: Inferior mesenteric artery.

Figure 7 Comparison of inferior mesenteric artery actual stumps from left colectomies between groups, with horizontal reference to D2 predicted ligation levels and D3 predicted ligation levels. D₂PLL: D2 predicted ligation level; D₃PLL: D3 predicted ligation level; IMA: Inferior mesenteric artery.

Figure 8 Comparison of inferior mesenteric artery actual stumps from sigmoidectomies and left colectomies between groups, with horizontal reference to D2 predicted ligation levels and D3 predicted ligation levels. D₂PLL: D2 predicted ligation level; D₃PLL: D3 predicted ligation level; IMA: Inferior mesenteric artery.