A systematic review and meta‐analysis of variants of the branches of the superior mesenteric artery: the Achilles heel of right hemicolectomy with complete mesocolic excision?

Abstract

Aim:Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation) is essential for adequate oncological resection during right hemicolectomy with complete mesocolic excision. This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon.Methods: A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, Scopus and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software.Results:A total of 41 studies (n = 4691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4%-99.8%), 72.6% (95% CI 61.3%-82.5%) and 96.9% (95% CI 94.2%-98.8%) respectively of patients. Supernumerary RCA and MCA were observed in 3.2% and 11.4% respectively of all cases. The RCA shared a common trunk with the ICA and MCA in 13.2% and 17.7% respectively of patients. A retro-superior mesenteric vein course of the ICA and RCA was observed in 55.1% and 11.4% respectively of all cases. Conclusion:The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-superior mesenteric vein courses. These variations should be taken into consideration during right hemicolectomy with complete mesocolic excision to ensure adequate oncological resection while minimizing intra-operative complications.

Variation of the ileocolic artery and superior mesenteric artery in a patient with right-sided colon cancer with Lynch syndrome: a case report

“…However, Spasojevic et al found that the ICA was absent in 2 out of 50 cases detected by multidetector CT angiography ( 10 ). Also, in Cirocchi et al ’s study, among 60 patients with malignant colonic cancer who underwent laparoscopic radical right colectomy and D3 lymph node dissection, there were 2 cases in which the ICA was absent, and the ICV was present in all 60 cases ( 11 ). Our paper is the first to report a case of two branches of the ICA originating from the SMA.…”

The vessels around the transverse colon mesentery – An investigation using 44 cadaver specimens and 505 cases in which dynamic computed tomography angiography was performed

“…Many reports have described the anatomy of the ileocolic and right colic artery and vein. (4)(5)(6)(7)(8)(9)(10)(11)(12)(20)(21)(22) Moreover, the effect of lymph node dissection in right colectomy has been reported. (23,24) Surgery for transverse colon cancer is highly di cult because of the many variations of the MCA and SMV branches.…”

“…The frequency of ileocolic artery and right colic artery and vein variations (4)(5)(6)(7)(8)(9)(10)(11)(12) and accessary middle colic artery (13)(14)(15)(16)) has been reported, but few of studies have focused on the middle colic artery (MCA) (17,18) and no studies have focused on the relationship between the MCA and superior mesenteric vein (SMV). We considered that the relationship between the MCA and SMV has been very important in the case of lymph node dissection around the MCA.…”

Assessment of adjuvant chemotherapy benefits after complete mesocolic excision in patients with colon cancer: Reanalysis of data from the ESCME trial

“…The technique of colon cancer surgery has been completed and standardized since Hohenberger et al [8] proposed complete mesocolic excision (CME) by combining lymphatic drainage with mesocolic plane dissection, in which the embryological mesocolon, from the viscera to the parietal planes, is removed horizontally and the main artery pedicle is ligated at the root in the vertical direction. Recent studies showed that CME could eliminate tumour tissue by removing the entire relevant mesentery, thereby reducing local recurrence and improving survival significantly [9–13]. However, most studies regarding AC were performed at a time when CME was not proposed and generalized [14].…”

“…drainage with mesocolic plane dissection, in which the embryological mesocolon, from the viscera to the parietal planes, is removed horizontally and the main artery pedicle is ligated at the root in the vertical direction. Recent studies showed that CME could eliminate tumour tissue by removing the entire relevant mesentery, thereby reducing local recurrence and improving survival significantly [9][10][11][12][13].…”