THREATENED RETROPERITONEAL MARGIN IN RIGHT COLON CANCER. PREOPERATIVE ASSESMENT THROUGH 3D-RECONSTRUCTION MATHEMATICAL MODEL
EAES Academy. Jeri S. 07/05/22; 366544; P287
Dr. Sebastian Jeri
Contributions
Contributions
Abstract
INTRODUCTION & OBJETIVES
The retroperitoneal margin infiltration in oncological right colectomy has been related to augmented risk of locoregional recurrence and decrease in survival rates.
Surgeon’s knowledge of the embryological development is basic to obtain free surgical margins (R0) in right colon tumors with threatened retroperitoneal margin (TRM) in preoperative imaging.
However, the specificity of preoperative computed tomography (CT scan) to evaluate the local extension of colon cancer is about 60 %.
The objective of this study is to show the utility of a 3D reconstruction mathematical model (3DMM) to obtain R0 surgeries in TRM tumors in right colon cancer.
MATERIALS & METHODS:
Applying a 3DMM to evaluate TRM in three real cases of right colon cancer.
Phase 1: development of a mathematical algorithm in a retrospective manner in two cases with right colon cancer and known TRM in CT scan. Development from concluded anatomic-pathology report (APR).
Phase 2: Prospective application of mathematical algorithm developed in phase 1 in a real case of right colon cancer with TRM in CT scan. Comparing CT scan report and 3DMM from the anatomic-pathology report.
RESULTS:
Phase 1:
Patient 1: Ascending colon neoplasm with suspicion of duodenal infiltration in CT scan. Right colectomy was performed without duodenal resection due to intraoperative findings. APR showed free retroperitoneal margin with a distance of the tumor to retroperitoneal margin of 4 mm. Retrospective 3DMM showed a minimum distance from the tumor to the duodenum of 6.24 mm and 9.8 mm to the pancreas.
Patient 2: Ascending colon neoplasm without suspicion of duodenal infiltration in CT scan. Right colectomy was performed extending resection to the duodenal flexure due to intraoperative findings. APR confirmed duodenal infiltration. Retrospective 3DMM showed duodenal infiltration with an infiltration volume of 0.4 mm.
Phase 2: Patient with ascending colon tumor with doubt of anterior renal fat infiltration in CT scan. Prospective 3DMM ruled out retroperitoneal infiltration (distance from tumor to retroperitoneal fascia of 0.1 mm). En bloc right colectomy was performed extending resection to retroperitoneal fascia and retroperitoneal fat. APR discarded retroperitoneal fascia and fat infiltration. R0 resection.
CONCLUSIONS:
A 3D reconstruction mathematical model can useful to evaluate tumor infiltration of the retroperitoneal margin in right colon cancer. This preoperative tool may help in the surgical strategy to obtain R0 oncological resections.
The retroperitoneal margin infiltration in oncological right colectomy has been related to augmented risk of locoregional recurrence and decrease in survival rates.
Surgeon’s knowledge of the embryological development is basic to obtain free surgical margins (R0) in right colon tumors with threatened retroperitoneal margin (TRM) in preoperative imaging.
However, the specificity of preoperative computed tomography (CT scan) to evaluate the local extension of colon cancer is about 60 %.
The objective of this study is to show the utility of a 3D reconstruction mathematical model (3DMM) to obtain R0 surgeries in TRM tumors in right colon cancer.
MATERIALS & METHODS:
Applying a 3DMM to evaluate TRM in three real cases of right colon cancer.
Phase 1: development of a mathematical algorithm in a retrospective manner in two cases with right colon cancer and known TRM in CT scan. Development from concluded anatomic-pathology report (APR).
Phase 2: Prospective application of mathematical algorithm developed in phase 1 in a real case of right colon cancer with TRM in CT scan. Comparing CT scan report and 3DMM from the anatomic-pathology report.
RESULTS:
Phase 1:
Patient 1: Ascending colon neoplasm with suspicion of duodenal infiltration in CT scan. Right colectomy was performed without duodenal resection due to intraoperative findings. APR showed free retroperitoneal margin with a distance of the tumor to retroperitoneal margin of 4 mm. Retrospective 3DMM showed a minimum distance from the tumor to the duodenum of 6.24 mm and 9.8 mm to the pancreas.
Patient 2: Ascending colon neoplasm without suspicion of duodenal infiltration in CT scan. Right colectomy was performed extending resection to the duodenal flexure due to intraoperative findings. APR confirmed duodenal infiltration. Retrospective 3DMM showed duodenal infiltration with an infiltration volume of 0.4 mm.
Phase 2: Patient with ascending colon tumor with doubt of anterior renal fat infiltration in CT scan. Prospective 3DMM ruled out retroperitoneal infiltration (distance from tumor to retroperitoneal fascia of 0.1 mm). En bloc right colectomy was performed extending resection to retroperitoneal fascia and retroperitoneal fat. APR discarded retroperitoneal fascia and fat infiltration. R0 resection.
CONCLUSIONS:
A 3D reconstruction mathematical model can useful to evaluate tumor infiltration of the retroperitoneal margin in right colon cancer. This preoperative tool may help in the surgical strategy to obtain R0 oncological resections.
INTRODUCTION & OBJETIVES
The retroperitoneal margin infiltration in oncological right colectomy has been related to augmented risk of locoregional recurrence and decrease in survival rates.
Surgeon’s knowledge of the embryological development is basic to obtain free surgical margins (R0) in right colon tumors with threatened retroperitoneal margin (TRM) in preoperative imaging.
However, the specificity of preoperative computed tomography (CT scan) to evaluate the local extension of colon cancer is about 60 %.
The objective of this study is to show the utility of a 3D reconstruction mathematical model (3DMM) to obtain R0 surgeries in TRM tumors in right colon cancer.
MATERIALS & METHODS:
Applying a 3DMM to evaluate TRM in three real cases of right colon cancer.
Phase 1: development of a mathematical algorithm in a retrospective manner in two cases with right colon cancer and known TRM in CT scan. Development from concluded anatomic-pathology report (APR).
Phase 2: Prospective application of mathematical algorithm developed in phase 1 in a real case of right colon cancer with TRM in CT scan. Comparing CT scan report and 3DMM from the anatomic-pathology report.
RESULTS:
Phase 1:
Patient 1: Ascending colon neoplasm with suspicion of duodenal infiltration in CT scan. Right colectomy was performed without duodenal resection due to intraoperative findings. APR showed free retroperitoneal margin with a distance of the tumor to retroperitoneal margin of 4 mm. Retrospective 3DMM showed a minimum distance from the tumor to the duodenum of 6.24 mm and 9.8 mm to the pancreas.
Patient 2: Ascending colon neoplasm without suspicion of duodenal infiltration in CT scan. Right colectomy was performed extending resection to the duodenal flexure due to intraoperative findings. APR confirmed duodenal infiltration. Retrospective 3DMM showed duodenal infiltration with an infiltration volume of 0.4 mm.
Phase 2: Patient with ascending colon tumor with doubt of anterior renal fat infiltration in CT scan. Prospective 3DMM ruled out retroperitoneal infiltration (distance from tumor to retroperitoneal fascia of 0.1 mm). En bloc right colectomy was performed extending resection to retroperitoneal fascia and retroperitoneal fat. APR discarded retroperitoneal fascia and fat infiltration. R0 resection.
CONCLUSIONS:
A 3D reconstruction mathematical model can useful to evaluate tumor infiltration of the retroperitoneal margin in right colon cancer. This preoperative tool may help in the surgical strategy to obtain R0 oncological resections.
The retroperitoneal margin infiltration in oncological right colectomy has been related to augmented risk of locoregional recurrence and decrease in survival rates.
Surgeon’s knowledge of the embryological development is basic to obtain free surgical margins (R0) in right colon tumors with threatened retroperitoneal margin (TRM) in preoperative imaging.
However, the specificity of preoperative computed tomography (CT scan) to evaluate the local extension of colon cancer is about 60 %.
The objective of this study is to show the utility of a 3D reconstruction mathematical model (3DMM) to obtain R0 surgeries in TRM tumors in right colon cancer.
MATERIALS & METHODS:
Applying a 3DMM to evaluate TRM in three real cases of right colon cancer.
Phase 1: development of a mathematical algorithm in a retrospective manner in two cases with right colon cancer and known TRM in CT scan. Development from concluded anatomic-pathology report (APR).
Phase 2: Prospective application of mathematical algorithm developed in phase 1 in a real case of right colon cancer with TRM in CT scan. Comparing CT scan report and 3DMM from the anatomic-pathology report.
RESULTS:
Phase 1:
Patient 1: Ascending colon neoplasm with suspicion of duodenal infiltration in CT scan. Right colectomy was performed without duodenal resection due to intraoperative findings. APR showed free retroperitoneal margin with a distance of the tumor to retroperitoneal margin of 4 mm. Retrospective 3DMM showed a minimum distance from the tumor to the duodenum of 6.24 mm and 9.8 mm to the pancreas.
Patient 2: Ascending colon neoplasm without suspicion of duodenal infiltration in CT scan. Right colectomy was performed extending resection to the duodenal flexure due to intraoperative findings. APR confirmed duodenal infiltration. Retrospective 3DMM showed duodenal infiltration with an infiltration volume of 0.4 mm.
Phase 2: Patient with ascending colon tumor with doubt of anterior renal fat infiltration in CT scan. Prospective 3DMM ruled out retroperitoneal infiltration (distance from tumor to retroperitoneal fascia of 0.1 mm). En bloc right colectomy was performed extending resection to retroperitoneal fascia and retroperitoneal fat. APR discarded retroperitoneal fascia and fat infiltration. R0 resection.
CONCLUSIONS:
A 3D reconstruction mathematical model can useful to evaluate tumor infiltration of the retroperitoneal margin in right colon cancer. This preoperative tool may help in the surgical strategy to obtain R0 oncological resections.
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