Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2024; 16(5): 1311-1319
Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1311
Evaluating the use of three-dimensional reconstruction visualization technology for precise laparoscopic resection in gastroesophageal junction cancer
Dan Guo, Xiao-Yan Zhu, Shuai Han, Yu-Shu Liu, Da-Peng Cui
Dan Guo, Yu-Shu Liu, Da-Peng Cui, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Xiao-Yan Zhu, Shuai Han, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
Author contributions: Guo D performed the research and wrote the paper; Zhu XY, Han S, and Liu YS organized the data and contributed to data analysis; Cui DP designed the research and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Hebei North University.
Informed consent statement: Because this was a retrospective study, the requirement for informed consent was waived.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Peng Cui, MM, Associate Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Zhangjiakou 075000, Hebei, China. yfycuidapeng@163.com
Received: December 19, 2023
Revised: January 18, 2024
Accepted: April 3, 2024
Published online: May 27, 2024
Processing time: 156 Days and 8.2 Hours
Abstract
BACKGROUND

Laparoscopic gastrectomy for esophagogastric junction (EGJ) carcinoma enables the removal of the carcinoma at the junction between the stomach and esophagus while preserving the gastric function, thereby providing patients with better treatment outcomes and quality of life. Nonetheless, this surgical technique also presents some challenges and limitations. Therefore, three-dimensional reconstruction visualization technology (3D RVT) has been introduced into the procedure, providing doctors with more comprehensive and intuitive anatomical information that helps with surgical planning, navigation, and outcome evaluation.

AIM

To discuss the application and advantages of 3D RVT in precise laparoscopic resection of EGJ carcinomas.

METHODS

Data were obtained from the electronic or paper-based medical records at The First Affiliated Hospital of Hebei North University from January 2020 to June 2022. A total of 120 patients diagnosed with EGJ carcinoma were included in the study. Of these, 68 underwent laparoscopic resection after computed tomography (CT)-enhanced scanning and were categorized into the 2D group, whereas 52 underwent laparoscopic resection after CT-enhanced scanning and 3D RVT and were categorized into the 3D group. This study had two outcome measures: the deviation between tumor-related factors (such as maximum tumor diameter and infiltration length) in 3D RVT and clinical reality, and surgical outcome indicators (such as operative time, intraoperative blood loss, number of lymph node dissections, R0 resection rate, postoperative hospital stay, postoperative gas discharge time, drainage tube removal time, and related complications) between the 2D and 3D groups.

RESULTS

Among patients included in the 3D group, 27 had a maximum tumor diameter of less than 3 cm, whereas 25 had a diameter of 3 cm or more. In actual surgical observations, 24 had a diameter of less than 3 cm, whereas 28 had a diameter of 3 cm or more. The findings were consistent between the two methods (χ2 = 0.346, P = 0.556), with a kappa consistency coefficient of 0.808. With respect to infiltration length, in the 3D group, 23 patients had a length of less than 5 cm, whereas 29 had a length of 5 cm or more. In actual surgical observations, 20 cases had a length of less than 5 cm, whereas 32 had a length of 5 cm or more. The findings were consistent between the two methods (χ2 = 0.357, P = 0.550), with a kappa consistency coefficient of 0.486. Pearson correlation analysis showed that the maximum tumor diameter and infiltration length measured using 3D RVT were positively correlated with clinical observations during surgery (r = 0.814 and 0.490, both P < 0.05). The 3D group had a shorter operative time (157.02 ± 8.38 vs 183.16 ± 23.87), less intraoperative blood loss (83.65 ± 14.22 vs 110.94 ± 22.05), and higher number of lymph node dissections (28.98 ± 2.82 vs 23.56 ± 2.77) and R0 resection rate (80.77% vs 61.64%) than the 2D group. Furthermore, the 3D group had shorter hospital stay [8 (8, 9) vs 13 (14, 16)], time to gas passage [3 (3, 4) vs 4 (5, 5)], and drainage tube removal time [4 (4, 5) vs 6 (6, 7)] than the 2D group. The complication rate was lower in the 3D group (11.54%) than in the 2D group (26.47%) (χ2 = 4.106, P < 0.05).

CONCLUSION

Using 3D RVT, doctors can gain a more comprehensive and intuitive understanding of the anatomy and related lesions of EGJ carcinomas, thus enabling more accurate surgical planning.

Keywords: Gastroesophageal junction cancer, Endoscopy, Tumor resection, Three-dimensional reconstruction visualization, Two-dimensional imaging, computed tomography

Core Tip: Three-dimensional reconstruction visualization technology (3D RVT) provides a more comprehensive and intuitive understanding of the anatomy and related lesions at the gastroesophageal junction. This study compared the 2D group, which underwent laparoscopic resection surgery after computed tomography (CT)-enhanced scanning, with the 3D group, which underwent laparoscopic resection surgery after CT-enhanced scanning and 3D RVT. Our findings highlight the benefits of using 3D RVT to improve surgical outcomes and reduce complications in patients with gastroesophageal junction cancer.