Fletcher Jordan, Lung Phillip, Van Eetvelde Ellen, Bertelsen Claus Anders, Stearns Adam, Storli Kristian, Miskovic Danilo
St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Colorectal Dis. 2025 Mar;27(3):e70025. doi: 10.1111/codi.70025.
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.
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.
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).
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.
结肠癌的完整结肠系膜切除术（CME）与改善肿瘤学预后相关，但需要详细了解复杂的肠系膜血管系统。源自患者影像的三维（3D）重建模型可增强术前解剖学理解，实现更安全、精准的CME。
在这项两阶段、双盲、交叉研究中，四位CME专家外科医生在CT扫描和3D模型上评估肠系膜血管解剖结构。在第一阶段，外科医生评估了66例病例，第二阶段对其中20例进行了重新评估。主要结局指标是通过Fleiss卡方检验评估的评分者间信度。次要结局指标是通过Cohen卡方检验评估的评分者内信度，以及在标准化问卷上以正确回答百分比衡量的解剖学准确率。
在第一阶段，3D模型的评分者间一致性（平均卡方值0.6，中等一致性）高于CT扫描（平均卡方值0.1，一致性差）。回结肠静脉引流和回结肠动脉走行在3D成像中显示出最高的卡方值（分别为0.85和0.93）。在所有外科医生中，3D成像的准确率也高于CT（平均89.7%正确）（平均79.1%正确，P < 0.001）。在第二阶段，3D成像的评分者内信度（平均Cohen卡方值0.61）仍然高于CT扫描（Cohen卡方值0.27）。
与传统CT扫描相比，3D肠系膜模型显著提高了CME专家之间的评分者间和评分者内信度，同时显著提高了对关键右侧结肠血管系统的解剖学理解准确率。3D规划可通过实现这些血管更好的术前可视化来促进CME。
