Learning objectives
● Review the usefulness of venous volumetric reconstruction of contrast enhanced CT studies for the assessment of venous vascularization of colon adenocarcinoma.
● Assess the usefulness of venous volume reconstruction as "surgical map" for colorectal laparoscopic surgeon.
● Illustrate the correlation between radiological imaging,
surgery with complete excision of the mesocolon and histopathologic analysis cases in our institution.
Background
Currently,
CT is necessary for preoperative staging in colon adenocarcinoma.
Complete cleavage of the mesocolon containing tumor drainage has showns increase survival and decrease the percentage of locoregional recurrence.
This surgical excision depends on the vascularization that nourishes the tumor.
Venous return must be incorporated into the surgical specimen to increase the number of nodes removed and thus facilitate prognosis evaluation and the need for adjuvant chemotherapy.
The tumor drainage veins are different depending on its location and can be studied by computed tomography,
like...
Findings and procedure details
Anatomy and Physiology
Venous drainage of the abdominal viscera is produced by a series of veins that end into the portal vein.
Although there are many anatomical variants,
usually the inferior mesenteric vein and splenic vein converge to form the splenomesenteric trunk.
Then this trunk joins the superior mesenteric vein to form the portal vein.
In turn,
these major veins are formed by the confluence of minor veins.
Typically,
the venous system is satellite to the arterial one.
This justifies the evaluation of the arterial...
Conclusion
Venous tridimensional reconstruction facilitates the interpretation of the anatomy of venous drainage tumor.
This allows complete cleavage of the mesocolon containing tumor drainage and reduces the incidence of intraoperative complications.
References
1.
Hohenberger W,
Weber K,
K Matzel,
Papadopoulos T,
Merkel S.
Standardized surgery for colonic cancer: mesocolic complete excision and central ligation-technical notes and outcome.
Colorectal Dis.
2009,
11 (4): 354-65.
2.
Watanabe T,
Itabashi M,
Shimada Y,
Tanaka S,
Ito Y,
Ajioka And,
Japanese Society for Cancer of the Colon and rectum,
et al.
Japanese Society for Cancer of the Colon and Rectum (JSCCR) 2010 guidelines for the treatment of colorectal cancer.
Int J Clin Oncol.
2012; 17 (1): 1-29.
3.
Gillot C,
Hureau...