Retromesenteric course of the middle colic artery—challenges and pitfalls in D3 right colectomy for cancer

Štimec, Bojan; Andersen, Bjarte Tidemann; Benz, Stefan; Fasel, Jean; Augestad, Knut Magne; Ignjatović, Dejan

doi:10.1007/s00384-018-2987-9

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…The classification of the relationship between MCA bifurcation position and left edge of SMV has been reported [ 21 ]. In this study, we showed the patterns of intersection between the left edge of the SMV and the MCA branch and the frequency of each relationship [ 42 ]. It was suggested that the SMV could be used a landmark for sufficient and necessary lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Cadaveric and CT angiography study of vessels around the transverse colon mesentery

et al. 2023

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Background Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. Methods This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. Results The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). Conclusions This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Cadaveric and CT angiography study of vessels around the transverse colon mesentery

et al. 2023

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show abstract

“…In this study, we showed the patterns of intersection between the left edge of the SMV and the MCA branch and the frequency of each relationship. (39) It was suggested that the SMV could be used a landmark for su cient and necessary lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

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

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Ishimaru

et al. 2022

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Background. Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen, and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. Methods. This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. Results. The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: Type I, branching right and left from common trunk; Type II, the right and left branches bifurcated separately from the SMA; and Type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, Type IIa with one left branch and Type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: Type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); Type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). Conclusions. This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be practically useful.

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CT and operative images for evaluation of right colectomy with extended D3 mesenterectomy anterior and posterior to the mesenteric vessels

et al. 2019

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Background There has been a lengthy discussion on the extent of lymphatic resection for right-sided colon cancer and the central borders of the mesentery that are not yet defined. The objectives of this study are to define minimal clearances for adequate lymphatic resection in regard to colic artery origins and the superior mesenteric artery (SMA) and vein (SMV) relevant to right colectomy. Methods Central mesenteric lymph vessels, nodes, and blood vessels were dissected in 16 cadavers. Cranial-caudal clearances were defined as distances between an individual colic artery origin (ileocolic, right colic, and median colic artery) and the outermost lymphatic vessel within its lymphovascular bundle, cranial and caudal along the SMA. Long lymphatic vessels crossing the SMV between arterial bundles were counted and they constituted the medial clearances. An arbitrary watershed between small bowel and colonic lymph was localized. Immunohistochemistry was performed to histologically verify lymphatic vessels. Results Cranial-caudal clearances were ileocolic 3.6 ± 1.9 and 5.7 ± 1.9; right colic 2.8 ± 1.6 and 3.3 ± 1.0; middle colic artery bundle 6.3 ± 2.7 and 5.9 ± 2.4 mm, respectively. Long lymphatic vessels crossing the SMV between arterial buntles and approaching the SMA were found in all cadavers (antero/posteriorly in 12, only anteriorly in 4), median 3.5 (1-7) long lymphatic vessels anteriorly, and 1.5 (0-5) posteriorly per cadaver. Conclusions Right colonic lymphovascular bundles are volumes of mesenteric tissue that surround the superior mesenteric vessels anteriorly and posteriorly. Long lymphatic vessels traverse the superior mesenteric vein anteriorly/posteriorly approaching the superior mesenteric artery between arterial bundles and placing the medial clearance on the left side of the artery. These do not correlate to arterial crossing patterns. Cranial-caudal clearances determine the tissue to be removed superior/inferior to arterial origins together with long lymphatic vessels transversing independently between the lymphovascular bundles placing the weight of lymphatic resection on the mesenteric tissue and not on the level of vessel division (High tie).

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Retromesenteric course of the middle colic artery—challenges and pitfalls in D3 right colectomy for cancer

Cited by 3 publications

References 29 publications

Cadaveric and CT angiography study of vessels around the transverse colon mesentery

Cadaveric and CT angiography study of vessels around the transverse colon mesentery

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

CT and operative images for evaluation of right colectomy with extended D3 mesenterectomy anterior and posterior to the mesenteric vessels

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