[D2 Lymph Node Dissection in Mini-Laparotomy Transverse Colectomy Using Non-Contrast Simulation CT Colonography].

Area of Science:

• Surgical Oncology
• Medical Imaging
• Colorectal Surgery

Background:

• Simulation computed tomography colonography (S-CTC) combines CT colonography with 3D vascular imaging for colorectal cancer surgery.
• Creating 3D vascular images from non-contrast CT is challenging.
• D2 lymph node dissection during mini-laparotomy transverse colectomy for mid-transverse colon cancer is technically difficult.

Observation:

• A 77-year-old male patient with Stage I transverse colon cancer and chronic renal failure underwent non-contrast CT.
• 3D arterial and venous structures were clearly visualized using non-contrast CT and processed on workstation Zaiostation2.
• The dominant artery was identified as the left branch of the middle colic artery (MCA Lt), with its right branch (MCA Rt) and accessory MCA (AMCA) significantly distant.

Findings:

• Non-contrast S-CTC successfully visualized vascular anatomy, including the MCA Lt and its draining vein from the superior mesenteric vein.
• The technique facilitated simulation of D2 lymph node dissection, including the branching root of MCA Lt and accompanying vein.
• Mini-laparotomy transverse colectomy was successfully performed through a 7 cm incision, guided by the S-CTC simulation.

Implications:

• Non-contrast S-CTC is a valuable tool for planning complex D2 lymph node dissections in minimally invasive colorectal surgery.
• This approach can enhance surgical precision and potentially improve outcomes in transverse colectomy.
• The study demonstrates the feasibility of using non-contrast CT-based S-CTC for detailed pre-operative surgical planning.