Evaluation of the vascular anatomy of the left‐sided colon focused on the accessory middle colic artery: a single‐centre study of 734 patients

Miyake, Hiroaki; Murono, Koji; Kawai, Kazushige; Hata, Keisuke; Tanaka, Tomoko; Nishikawa, Takeshi; Otani, Kensuke; Sasaki, Kenji; Kaneko, Manabu; Emoto, Shigenobu; Nozawa, Hiroaki

doi:10.1111/codi.14287

Cited by 35 publications

(39 citation statements)

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“…Moreover, the AMCA originated from the SMA in more than 90% of the patients. This result is also consistent with that of our previous study [7]. The lymph nodes around the AMCA should be dissected during the surgery for cancer of the splenic flexure.…”

Section: Discussionsupporting

confidence: 93%

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Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

et al. 2019

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Aim Recently, the accessory middle colic artery (AMCA) has been recognized as the vessel that supplies blood to the splenic flexure. However, the positional relationship between the AMCA and inferior mesenteric vein (IMV) has not been evaluated. Herein, we aimed to evaluate the anatomy of the AMCA and the splenic flexure vein (SFV). Method Two hundred and five patients with colorectal cancer who underwent enhanced CT preoperatively were enrolled in the present study. The locations of the AMCA and IMV were evaluated, focusing on the positional relationship between the vessels and pancreas – below the pancreas or to the dorsal side of the pancreas. Results The AMCA was observed in 74 (36.1%) patients whereas the SFV was found in 177 (86.3%) patients. The left colic artery (LCA) was the major artery accompanying the SFV in 87 (42.4%) of patients. The AMCA accompanied the SFV in 65 (32.7%) patients. In 15 (7.8%) patients, no artery accompanied the SFV. The origin of the AMCA was located on the dorsal side of the pancreas in 15 (20.3%) of these 74 patients. Similarly, the destination of the IMV was located on the dorsal side of the pancreas in 65 (31.7%) of patients. Conclusion The SFV was observed in most patients, and the LCA or AMCA was the common accompanying artery. In some patients these vessels were located on the dorsal side of the pancreas and not below it. Preoperative evaluation of this anatomy may be beneficial for lymph node dissection during left‐sided hemicolectomy.

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Section: Discussionsupporting

confidence: 93%

“…Typically, the AMCA originates from the superior mesenteric artery (SMA), running below the pancreas and toward the splenic flexure. In a previous report, the AMCA was observed in 36.4% of patients, and the incidence reached 85.3% in patients with a deficit in the LCA .…”

Section: Introductionmentioning

confidence: 72%

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

et al. 2019

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“…For patients with an accessory MCA, blood flow through the SMA may be more prevalent in the mesenteric circulation, thus leading to safer IMA ligation. However, in the absence of an accessory MCA or intermesenteric artery, the mesenteric blood flow leading to the LCA from the IMA appears to be more important in the maintenance of perfusion status of the left colon [22]. In this study, the IMA length was revealed as an independent predictor of critically low MAP index after IMA clamping.…”

Section: Discussionmentioning

confidence: 65%

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

et al. 2019

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Purpose Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. Methods This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. Results Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. Conclusion Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery.

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“…Further studies confirmed these findings highlighting that blood flow from the transverse colon showed a highly variable anatomy (left branch of middle colic artery, artery for the transverse colon, accessory artery for the transverse colon), while the middle colic artery is completely absent in 20% of cases and a 'true' middle colic artery could be found in only 46% of specimens [18,19]. More recently, an accessory middle colic artery running towards the splenic flexure was identified in about onethird of patients, branching from the superior mesenteric artery in the majority of cases [20]. Using laparoscopic scintigraphic mapping, Vasey et al found that lymphatic drainage of the normal splenic flexure was preferentially directed towards the left colic pedicle with 9.2 times greater flow compared with the middle colic pedicle [21].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

et al. 2019

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Aim The optimal surgical treatment of splenic flexure neoplasm is still not well defined. Extended right hemicolectomy (ERH) and left colic resection (LCR) have been proposed but conclusive evidence concerning postoperative morbidity and oncological results is lacking. The aim of this study was to analyse the short-term outcomes after surgery for splenic flexure cancer with regard to surgical procedure and surgeon's specialty.Methods This was a multicentre study on patients who underwent surgery for primary colon cancer of the splenic flexure.Results From 2004 to 2015, 324 patients fulfilled the criteria for inclusion into the study; 270 (83.4%) had elective surgery while 54 (16.6%) had emergency resection: 158 (48.8%) underwent ERH and 166 (51.2%) LCR; 176 (54.3%) procedures were performed by colorectal surgeons, 148 (46.7%) by general surgeons. In the ERH group a significantly higher rate of emergency operations was carried out (P = 0.005). After elective surgery, no significant differences between ERH and LCR concerning 30-day mortality (3.3% vs 2.0%) and the need for reoperation (10.6% vs 7.4%) were found.Nodal harvesting was significantly higher in the ERH and colorectal surgeon groups in any clinical scenario. At multivariate analysis, age and smoking habit were predictive of the need for reoperation and major morbidity while the general surgeon group showed a higher risk of anastomotic failure (OR = 1.92; P = 0.168).Conclusion We analysed the largest series in literature of curative resections for splenic flexure tumours. The optimal procedure still remains debatable as ERH and LCR appear to achieve comparable short-term outcomes. Surgeon's specialty seems to positively affect patient's outcomes.Keywords Colon cancer, splenic flexure, surgery, extended right hemicolectomy, left colon resection, surgeon's specialty What does this paper add to the literature? This is the largest series analysing the surgical treatment of splenic flexure cancer comparing the short-term outcomes of two different surgical techniques performed by two different types of surgeons: general surgeons and colorectal surgeons.

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Evaluation of the vascular anatomy of the left‐sided colon focused on the accessory middle colic artery: a single‐centre study of 734 patients

Abstract: The presence of the AMCA is not rare and the AMCA has some branching patterns; therefore, recognizing it preoperatively and intra-operatively is important, being especially careful when the LCA is absent.

Cited by 35 publications

References 14 publications

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short‐term outcomes

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