The right colic artery: An anatomical demonstration and its relevance in the laparoscopic era

Abstract

INTRODUCTION Hemicolectomies are not tailored in right-sided colon cancer resections, despite significant variation in the incidence and origin of the right colic artery (RCA). Early evidence suggests that removal of the relevant lymphovascular package and associated cancer as part of complete mesocolic excision (CME), rather than the entire right colon, may produce better outcomes. Advancing laparoscopic techniques are making this possible, and so it is increasingly important to more precisely define the anatomy of the RCA. METHODS To demonstrate the incidence and variation of the RCA, 25 formalin embalmed cadavers were dissected. Consent to dissection and photography was obtained under Human Tissue Act regulations. RESULTS Eleven female and 14 male cadavers (mean age 79.7 years, range 41-95 years) were included. The RCA originated from the right branch of the middle colic artery in nine cadavers (36%), while it arose from the superior mesenteric artery in eight cases (32%) and from the ileocolic or root of the middle colic artery in a smaller number of specimens. The RCA was absent in two individuals. CONCLUSIONS The RCA arises from the right branch of the middle colic artery in a considerable number of cases. The literature to date does not reflect the precision of anatomical understanding required for CME; hence, a new definition for the right colic vessel is proposed.

Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

“…The studies were published between 1909–2017, with a sample size ranging from 9 to 610 specimens. The superior mesenteric vessels and their branches were investigated by dissections of cadaveric specimens in 21 studies 15 , 16 , 22 – 27 , 29 , 38 , 39 , 44 , 45 , 49 , 52 , 54 – 59 , by imaging methods in 16 studies (CT − 13 studies 18 , 21 , 28 , 32 – 35 , 37 , 40 , 43 , 50 , 51 , 53 , MRI – one study 41 , CT and surgery – one study 20 , Angiography – one study 46 ), and by dissection during surgical procedures in eight studies (surgical dissection only – six studies 17 , 30 , 31 , 36 , 47 , 48 , surgical dissection and angiography – one study 42 , surgical and cadaveric dissection – one study 19 ).…”

Right colic artery anatomy: a systematic review of cadaveric studies

“…Significant confusion has arisen over the decades as a result of the multiple attempts to provide a unifying definition for the right colic feeding vessel [ 21 ]. Traditionally within a surgical context it was regarded as any artery directed towards the hepatic flexure of the colon; however, no consideration was given to its origin [ 26 , 27 ].…”

“…It is absent in 8.9% of cases, and two RCAs may be found in 7.0% of individuals. Only a few smaller data series described the RBMC as a potential origin of the RCA [ 21 , 27 ], resulting in a low (weighted) mean incidence for this particular arrangement. When all of this knowledge is applied to resection of a right colon tumour with CME technique, one is obligated to trace the tumour’s lymphovascular drainage back to the ILC or MCA in approximately 60% of cases, but in the remaining 40% a more extensive and proximal dissection to reach the SMA itself will be necessary.…”

An Unconventional Origin of the Right Colic Artery: A Case Report

“…Few reports in the literature communicate cases in which a common trunk for the right colic artery and the middle colic artery exists, further extending knowledge of the variation of right colic artery from the middle colic artery. Haywood, et al (2016), Ignjatovic, et al (2007), Michels, et al (1965), Gamo, et al (2016), and Haywood, et al (2017) note cases of a common stem shared by the right and middle colic arteries, branching from the superior mesenteric artery -alternately described as a right colic artery arising from the proximal middle colic artery prior to its branching into the right and left branches of the middle colic arteries. The incidences of the right colic-middle colic common stem extended from 3.33% [8] to 52% [9].…”

“…Our case report contributes to the literature in that it provides further data on the right colic-middle colic common trunk variation, where current research is limited. Our case also aims to promote greater recognition of the variation to potentially encourage additional research and analysis into the variation, ultimately allowing for an incidence rate of this particular variation of the right colic artery, to be approximated with greater precision [10][11][12][13][14].…”