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| 1 | Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision显示文摘BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely acclaimed as the new goldstandard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.AIM To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.METHODS This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation(group A) and non-standardized surgery(group B). The two groups were compared with regard to the arterial stump length after right-and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery(ICA) and inferior mesenteric artery(IMA) were compared with their theoretical best D2 position of predicted ligation levels(D2 PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded(specimen length, lymph node yield) and correlated with stump length.RESULTS We analysed 58 colectomies. The stump lengths(mean ± SD) in group A were16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm(χ~2 = 27.38, P < 0.001),which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height(0.26 ± 12.18 mm from D2 PLL; χ~2 = 0.005, P = 0.944).Apart from three left colectomies, group B failed to reach D2 PLL, by a mean difference of 32.14 ± 26.15 mm(χ~2 = 21.77, P < 0.001). The calculated improvement potentials were significantly shorter in group A than in group B, by a mean of 31.88 mm(χ~2= 22.13, P < 0.001). The large spread of results in group B showed that there is significant variability(P = 0.004) when compared to standard surgery. Significant correlations were found between stump length, specimen length and number of lymph nodes(P = 0.018 and P = 0.008 respectively). No statistical difference was found between observers' measurements(P = 0.866).CONCLUSION Arterial stump monitoring is a significant step in defining surgical quality, as longer stumps contain residual mesocolic tissue and correlate with major prognostic factors. | Cristian Livadaru Stefan Morarasu Tudor Cristian Frunza Florina A Ghitun Elena Florina Paiu-Spiridon Florina Sava Cristina Terinte Dan Ferariu Sorinel Lunca Gabriel Mihail Dimofte | 2019 | World Journal of Gastrointestinal Oncology2019，11，3： | 2 |
| 2 | Proton beam versus photon beam dose to the heart and left anterior descending artery for left-sided breast cancer显示文摘 | Lin LL Vennarini S Dimofte A | 2013 | Int Radiat Oncol Biol Phys2013，87，2： | 1 |
| 3 | Laparoscopic management of gastrointestinal stromal turnouts显示文摘 | T?rcoveanu E Dimofte G Vasilescu A | 2010 | Acta Chir Belg2010，110，3： | 1 |
| 4 | Laparoscopic management of gastrointestinal stromal turnouts 显示文摘 | Tarcoveanu E Dimofte G Vasilescu A | 2010 | Acta Chir Belg2010，110，3： | 1 |
| 5 | Laparoscopic managemerit of gastrointestinak stromal tumours 显示文摘 | Tarcoveanu E Dimofte G Vasilescu A | 2010 | Acta Chir Belg2010，110，3： | 1 |
| 6 | TNF alpha and IL-6 in- volvement in surgical trauma显示文摘 | Dimofte G Alexander A Carlson G | 2001 | Rev Med Chit Soc Med Nat Iasi2001，105，3： | 1 |
| 7 | A method for determination of the absorption and scattering properties interstitially in turbid media 显示文摘 | DIMOFTE A FINLAY J C ZHU T C | 2005 | Physics in Medicine and Biology2005，50，10： | 1 |
| 8 | Laparoseopie management of gastrointestinal stromal tumours显示文摘 | Tfireoveanu E Dimofte G Vasileseu A | 2010 | Acta Chir Belg2010，110，3： | 1 |
| 9 | In vivo light dosimetry for motexafin lutetium-mediated PDT of recurrent breast cancer显示文摘 | DIMOFTE A ZHU T C HAHN S M | 2002 | Lasers Surg Med2002，31，5： | 1 |
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