Evaluating the role of 3D visualisation in colorectal cancer surgery decision making
File(s)
Author(s)
Fletcher, Jordan
Type
Thesis
Abstract
Recent advancements in three-dimensional (3D) visualisation show promise for enhancing anatomical understanding and surgical precision, particularly in procedures such as complete mesocolic excision (CME) and pelvic exenteration for advanced rectal cancer. Despite potential benefits in preoperative planning, intraoperative guidance, and patient education, routine adoption remains limited. The absence of well-defined frameworks for systematic evaluation and integration contributes to variable uptake and hinders consensus on best practice. Further research is required to standardise implementation and appraisal methodologies, enabling broader adoption and robust clinical evidence generation.
This thesis addresses these limitations by developing, evaluating, and integrating patient-specific 3D anatomical models into the continuum of advanced colorectal cancer surgery. The research spans four domains: (1) technical innovation and validation of scalable workflows for generating high-quality models from standard imaging; (2) establishment of standardised frameworks for assessing accuracy, educational impact, and clinical utility; (3) evaluation of clinical feasibility in CME; and (4) application in improving patient comprehension and decision-making for pelvic exenteration. Methods include advanced image segmentation and mesh processing, systematic reviews of evaluation methods, and mixed-methods studies with surgical trainees, expert CME surgeons, and patients.
Key findings show that 3D reconstructions achieve high accuracy in predicting mesenteric vascular anatomy, significantly improve surgeons’ anatomical understanding, and enhance inter- and intra-rater reliability for CME planning. Patient-centred applications demonstrated improved understanding of surgical procedures, reduced decisional conflict, and support for shared decision-making. Surgeons reported practical value in both preoperative and intraoperative settings.
This work provides validated technical workflows, proposes evaluation frameworks, and demonstrates educational and clinical benefits. Findings establish a foundation for future research, including automated model generation and large-scale trials to assess long-term clinical outcomes. Addressing both technical and patient-centred dimensions, this thesis underscores the role of 3D visualisation in advancing surgical precision, safety, and collaborative decision-making in advanced colorectal cancer care.
This thesis addresses these limitations by developing, evaluating, and integrating patient-specific 3D anatomical models into the continuum of advanced colorectal cancer surgery. The research spans four domains: (1) technical innovation and validation of scalable workflows for generating high-quality models from standard imaging; (2) establishment of standardised frameworks for assessing accuracy, educational impact, and clinical utility; (3) evaluation of clinical feasibility in CME; and (4) application in improving patient comprehension and decision-making for pelvic exenteration. Methods include advanced image segmentation and mesh processing, systematic reviews of evaluation methods, and mixed-methods studies with surgical trainees, expert CME surgeons, and patients.
Key findings show that 3D reconstructions achieve high accuracy in predicting mesenteric vascular anatomy, significantly improve surgeons’ anatomical understanding, and enhance inter- and intra-rater reliability for CME planning. Patient-centred applications demonstrated improved understanding of surgical procedures, reduced decisional conflict, and support for shared decision-making. Surgeons reported practical value in both preoperative and intraoperative settings.
This work provides validated technical workflows, proposes evaluation frameworks, and demonstrates educational and clinical benefits. Findings establish a foundation for future research, including automated model generation and large-scale trials to assess long-term clinical outcomes. Addressing both technical and patient-centred dimensions, this thesis underscores the role of 3D visualisation in advancing surgical precision, safety, and collaborative decision-making in advanced colorectal cancer care.
Version
Open Access
Date Issued
2025-01-08
Date Awarded
01/09/2025
License URL
Advisor
Miskovic, Danilo
Lung, Phillip
Hanna, George
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)