Background: In vivo residual arterial pedicle length (RAPL) has been proposed as a quality indicator for central vascular ligation (CVL [i.e., RAPL ≤ 10 mm]) in colorectal cancer (CRC) surgery. However, its survival association in non-routine CVL practice requires clarification. This study aimed to assess the feasibility and reproducibility of measuring RAPL alongside its oncological associations in non-routine CVL surgery.

Methods: A prospective cohort study at Concord Hospital was conducted on anterior resection (AR) or right hemicolectomy (RH) patients with stage I to III CRC (1995-2019). Using surveillance computed tomography (CT), RAPL of the inferior mesenteric artery (IMA) or ileo-colic artery (ICA) pedicle was measured independently by two observers. The intra-class correlation coefficient assessed the reproducibility of the measurements. Kaplan-Meier and univariate Cox regression analyses estimated overall survival (OS) and disease-free survival (DFS), while univariate and multivariate linear regression models tested correlations between RAPL and clinicopathological features.

Results: A total of 1425 patients underwent a CRC operation. Post-operative CTs were reviewed in 424 patients, with 422 (mean age 69.0 years [SD 12.3]; 54.0% males) RAPLs measured. The majority studied underwent an AR (59.2%). Excellent inter-rater reliability was noted in AR (ICC = 0.97; P < 0.001) and RH (ICC = 0.89; P < 0.001) patients. No association was observed between RAPL and OS or DFS in either group. Also, RAPL lacked association with nodal harvest in either AR (P = 0.54) or RH (P = 0.16) patients.

Conclusion: The value of RAPL as a quality marker of CRC surgery in non-routine CVL practice has not been confirmed. Furthermore, its lack of association with nodal harvest emphasizes the importance and the need for comprehensive pathology examination of the specimen following resection of CRC.

Keywords: CME; CVL; Residual arterial pedicle length; Tissue morphometry.

© 2025. The Author(s).

背景： 体内残留动脉蒂长度（RAPL）已被提议作为结直肠癌（CRC）手术中中心血管结扎（CVL，即 RAPL ≤ 10 mm）的质量指标。然而，在非常规 CVL 实践中的生存关联仍需澄清。本研究旨在评估在非常规 CVL 手术中测量 RAPL 的可行性和可重复性及其与肿瘤学的关系。

方法： 这项前瞻性队列研究在 Concord 医院进行，对象是 1995 年至 2019 年间接受前切除术（AR）或右半结肠切除术（RH）的 I 至 III 期 CRC 患者。使用监测 CT 独立测量降结肠动脉 (IMA) 或回结肠动脉 (ICA) 蒂部的 RAPL，由两位观察员进行独立评估。使用组内相关系数来评估测量结果的可重复性。Kaplan-Meier 和单变量 Cox 回归分析估计总生存率（OS）和无病生存期（DFS），而单变量和多变量线性回归模型测试 RAPL 与临床病理特征之间的关联。

结果： 共有 1425 名患者接受了 CRC 手术。在 424 名患者的术后 CT 中进行了回顾，共测量了 422 名患者的 RAPL（平均年龄为 69.0 岁 [SD 12.3]；男性占 54.0%）。大多数接受的研究手术是前切除术 (AR)（占 59.2%）。在 AR 和 RH 患者中观察到了出色的评分者间一致性（AR 的 ICC = 0.97，P

结论： 在非常规 CVL 实践中，RAPL 作为 CRC 手术质量指标的价值尚未得到证实。此外，其与淋巴结收获缺乏相关性强调了对切除的 CRC 标本进行全面病理检查的重要性。

关键词： CME；CVL；残留动脉蒂长度；组织形态测量学。