Reappraisal of the Vascular Anatomy of the Colon and Consequences for the Definition of Surgical Resection

Abstract

Introduction: Databases of information on surgical treatment for colorectal cancer have been created in various countries and data have started to be released. The most important facets of research for statistical processing include the methodology and firm definitions of content. However, for trials involving colorectal cancer, the applicable terminology has not been defined, and much bias is frequently encountered. Starting from definitions of the colon and vascular system of the colon, we propose definitions of surgical procedures for colorectal cancer. Methodology: This paper reviews the colon segments and vascular anatomy of the colon. If surgical treatment of colon cancer is considered from this perspective, we can see that definitions for these surgical procedures are lacking. The definition of surgical treatment would also allow clarification of the range of lymph node dissection. In general, surgical procedures and the area of surgical lymph node dissection are both defined according to the basic structure of the associated arteries. However, the existing descriptions are not based on a definition of the arteries. We therefore tried to establish the most useful nomenclature for the arterial system of the large intestine for colorectal surgeons and reviewed the frequency of important arterial variations. Using the resulting definitions, we provided consistent definitions for colon cancer surgery. Conclusion: The segments of the colon need to be defined. In surgery, procedures are performed using the arteries as indicators, so vessels originating from the superior and inferior mesenteric arteries are referred to as arteries, with others are referred to as branches. Surgical treatment of colon cancer can be defined from the relationship between these arteries. For the first time, this may allow proper application of statistics for the treatment of colon cancer.

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

“…Griffith first reported that in the majority of cases the blood supply to the splenic flexure is carried through the left colic artery but in 11% of cases it is provided by the left branches of the middle colic artery [17]. 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].…”

Ethanol exposure drives colon location specific cell composition changes in a normal colon crypt 3D organoid model

“…While the colon is generally considered to be one organ, left and right colon display fundamental differences in vascular anatomy 5 and gene expression in arising tumors 6 . Epidemiological studies have revealed locationdependent differences in CRC incidence with respect to alcohol consumption.…”

Aberrant Left Colic Artery and Its Surgical Implications

“…Oncological resections in the colon are solely based on the principal artery supplying that segment of the colon. In case of aberrations such as in our case, routine left hemicolectomy for left colon cancer would have become inadequate due to the failure to dissect and divide the LCA at its origin [ 1 , 10 - 12 ]. In our own case, injury of the aberrant LCA during dissection would have been disastrous, and extended colonic resection to viable segment, sometimes subtotal colectomy would have been required.…”