Abstract
Aim
Complete mesocolic excision (CME) for colon cancer has been associated with improved oncological outcomes but requires a detailed understanding of complex mesenteric vasculature. Three-dimensional (3D) reconstructed models derived from patient imaging could enhance preoperative anatomical comprehension, enabling safer, precision CME.
Methods
In this two-phase, blinded, crossover study, four expert CME surgeons evaluated mesenteric vascular anatomy on CT scans and 3D models. In phase 1, surgeons assessed 66 cases, while 20 were re-evaluated in phase 2. The primary outcome measure was inter-rater reliability by Fleiss's kappa. Secondary outcomes were intra-rater reliability by Cohen's kappa and anatomical accuracy rates measured as a percentage of correct responses on a standardised questionnaire.
Results
In phase 1, inter-rater agreement was higher for 3D models (average kappa 0.6, moderate agreement) than for CT scans (average kappa 0.1, poor agreement). Ileocolic vein drainage and ileocolic artery trajectory showed the highest kappa values with 3D imaging (0.85 and 0.93, respectively). Accuracy was also superior with 3D across all surgeons (mean 89.7% correct) versus CT (mean 79.1% correct, P < 0.001). In phase 2, intra-rater reliability remained higher for 3D (average Cohen's kappa 0.61) than CT scans (Cohen's kappa 0.27).
Conclusion
3D mesenteric models significantly improve inter- and intra-rater reliability among CME experts over traditional CT scans while markedly enhancing anatomical comprehension accuracy about critical right-sided colonic vasculature. 3D planning could facilitate CME by enabling superior preoperative visualisation of these vessels.
Complete mesocolic excision (CME) for colon cancer has been associated with improved oncological outcomes but requires a detailed understanding of complex mesenteric vasculature. Three-dimensional (3D) reconstructed models derived from patient imaging could enhance preoperative anatomical comprehension, enabling safer, precision CME.
Methods
In this two-phase, blinded, crossover study, four expert CME surgeons evaluated mesenteric vascular anatomy on CT scans and 3D models. In phase 1, surgeons assessed 66 cases, while 20 were re-evaluated in phase 2. The primary outcome measure was inter-rater reliability by Fleiss's kappa. Secondary outcomes were intra-rater reliability by Cohen's kappa and anatomical accuracy rates measured as a percentage of correct responses on a standardised questionnaire.
Results
In phase 1, inter-rater agreement was higher for 3D models (average kappa 0.6, moderate agreement) than for CT scans (average kappa 0.1, poor agreement). Ileocolic vein drainage and ileocolic artery trajectory showed the highest kappa values with 3D imaging (0.85 and 0.93, respectively). Accuracy was also superior with 3D across all surgeons (mean 89.7% correct) versus CT (mean 79.1% correct, P < 0.001). In phase 2, intra-rater reliability remained higher for 3D (average Cohen's kappa 0.61) than CT scans (Cohen's kappa 0.27).
Conclusion
3D mesenteric models significantly improve inter- and intra-rater reliability among CME experts over traditional CT scans while markedly enhancing anatomical comprehension accuracy about critical right-sided colonic vasculature. 3D planning could facilitate CME by enabling superior preoperative visualisation of these vessels.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | e70025 |
| Tidsskrift | Colorectal Disease |
| Vol/bind | 27 |
| Udgave nummer | 3 |
| Antal sider | 14 |
| ISSN | 1462-8910 |
| DOI | |
| Status | Udgivet - 2025 |
Bibliografisk note
Publisher Copyright:© 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.