The potential of preoperative three-dimensional computed tomography for para-aortic lymphadenectomy in gynecological malignancies

Background The evaluation of anatomical abnormalities involving urinary vessel variations prior to para-aortic lymphadenectomy in gynecological malignancies is challenging. In this context, the utility of preoperative three-dimensional (3D) computed tomography (3DCT) angiography in improving surgical outcomes was examined. Methods This observational study evaluated the utility of 3DCT in patients who underwent para-aortic lymphadenectomy between January 2023 and November 2024. 3D fusion images were constructed from the arterial phase (CTA), CT-venography (CTV), and CT-urography (CTU). A total of 72 patients were included and divided into two groups: Non-3DCT and 3DCT. Outcomes included detection rates of arterial, venous, or urinary tract variations and surgical outcomes, including complications, in both groups. Results The 3DCT group included 14/34 (41.2%) cases with renal vessel variations and two cases (5.9%) with double ureters; the non-3DCT group did not detect any anatomical abnormalities. In the 3DCT group, renal vessel and urinary tract variations were clearly shown. Postoperative complications tended to be slightly higher in the non-3DCT group, including lymphocyte infection, chylous leakage, and bowel obstruction. Postoperative CT revealed reduced contrast in the lower pole of the right kidney in the 3DCT case with the most complex urinary vessel variations. Furthermore, in the 3DCT group, 8/34 (23.5%) unilateral or bilateral renal arteries were located caudally to the lower edge of the renal vein. Conclusion In gynecological malignancies, 3DCT before para-aortic lymphadenectomy was superior in identifying urinary vessel variations over conventional contrast-enhanced CT; thus, aiding realistic preoperative simulations and potentially reducing surgeons' burden and perioperative complications.