在接受直肠癌手术的患者中，外科医生与放射学对肠系膜下动脉结扎水平的评估存在差异，这影响了基于登记的研究和外科实践。

Discrepancy between surgeon and radiological assessment of ligation level of the inferior mesenteric artery in patients operated for rectal cancer-impacting registry-based research and surgical practice.

作者信息

Wikner Franciska, Matthiessen Peter, Sörelius Karl, Legrell Petter, Rutegård Martin

机构信息

Department of Radiation Sciences, Umeå University, Umeå, Sweden.

Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

出版信息

World J Surg Oncol. 2021 Apr 13;19(1):115. doi: 10.1186/s12957-021-02222-5.

DOI:10.1186/s12957-021-02222-5

PMID:33849560

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8045315/

Abstract

BACKGROUND

The reliability of the registered ligation level of the inferior mesenteric artery (IMA) in the Swedish Colorectal Cancer Registry has been questioned. The primary aim of this study was to evaluate this parameter in the registry by comparing the registered ligation levels with a postoperative computed tomography angiography (CT-angiography) in patients operated for rectal cancer.

METHODS

Patients operated for rectal cancer at two Swedish university hospitals were prospectively included between December 2016 and December 2019. At the 1-year postoperative follow-up, an additional CT-angiography was performed and independently examined by two radiologists. The radiological assessment of the ligation level was compared to registry data, using different measures of agreement.

RESULTS

A total of 94 patients were included, 55 (59%) were men and 39 (41%) women. All patients underwent abdominal resection: conventional or robot-assisted laparoscopic surgery, n=56 (60%), or open resection, n=38 (40%). The ligation level as assessed on CT-angiography was high in 29 (31%) patients and low in 65 (69%). The registered level of ligation of the IMA and the radiological assessment of the CT-angiographies were consistent in 77/94 cases, demonstrating an 82% agreement and a sensitivity and specificity of 86% and 72%, respectively. The estimated Kappa value was 0.58, reaching 0.64 after prevalence bias adjustment.

CONCLUSION

This study showed that CT-angiography can be used to evaluate the reliability of the registered ligation level in the Swedish Colorectal Cancer Registry. The demonstrated agreement between the registry and postoperative CT-angiography was moderate to good. This discrepancy impacts registry-based research using IMA ligation data and may ultimately influence surgical practice.

TRIAL REGISTRATION

Clinical Trials identifier NCT03875612.

摘要

背景

瑞典结直肠癌登记处记录的肠系膜下动脉（IMA）结扎水平的可靠性受到质疑。本研究的主要目的是通过比较直肠癌手术患者登记的结扎水平与术后计算机断层扫描血管造影（CT血管造影）来评估登记处的这一参数。

方法

前瞻性纳入2016年12月至2019年12月在两家瑞典大学医院接受直肠癌手术的患者。在术后1年随访时，进行额外的CT血管造影，并由两名放射科医生独立检查。使用不同的一致性测量方法，将结扎水平的放射学评估与登记数据进行比较。

结果

共纳入94例患者，其中55例（59%）为男性，39例（41%）为女性。所有患者均接受腹部切除术：传统或机器人辅助腹腔镜手术，n = 56（60%），或开放切除术，n = 38（40%）。CT血管造影评估的结扎水平在29例（31%）患者中为高位，在65例（69%）患者中为低位。IMA登记的结扎水平与CT血管造影的放射学评估在77/94例中一致，一致性为82%，敏感性和特异性分别为86%和72%。估计的Kappa值为0.58，经患病率偏倚调整后达到0.64。