Three-Dimensional Vascular Anatomy Relevant to Oncologic Resection of Right Colon Cancer

Abstract

We analyzed data on the three-dimensional vascular anatomy of the right colon from the operative documents of 215 patients undergoing oncologic resection for right colon cancer. The right colic artery (RCA) was absent in 146 patients (67.9%), with the ileocolic artery (ICA) crossing the superior mesenteric vein (SMV) ventrally in 78 patients (36.3%). When the RCA was present, both the ICA and the RCA crossed the SMV ventrally in 44 patients (20.5%), dorsally in 10 patients (4.7%), the RCA crossed the SMV ventrally and the ICA dorsally in 10 patients (4.7%), and the RCA crossed the SMV dorsally and the ICA ventrally in 5 patients (2.2%). The arterial branches toward the hepatic flexure crossed the SMV ventrally in 151 eligible cases: the branch originated from the common trunk of the middle colic artery in 97 patients (64.2%) and 1 and 2 arteries directly originated from the SMA in 49 patients (32.5%) and in 5 patients (3.3%), respectively. These data would be useful to safely perform lymph node dissection around the SMV.Key words: Superior mesenteric artery -Superior mesenteric vein -Colon cancerLymphadenectomy -Colectomy B ecause the superior mesenteric artery (SMA) is located mostly on the left side of the superior mesenteric vein (SMV), the branches originating directly from the SMA, such as the ileocolic artery (ICA), the right colic artery (RCA), and the middle colic artery (MCA), cross the SMV ventrally or dorsally. Familiarity with the three-dimensional relations of these arteries and the SMV would enable safer and easier performance of oncologic resection for right colon cancer. However, because Patients and MethodsThe subjects were 215 Japanese patients (127 men and 88 women) who underwent right (hemi) colectomy with standard lymph node dissection for right colon cancer through a conventional open or minilaparotomy approach 5-7 at our hospital between January 1999 and September 2009. The standard lymph node dissection included removal of the epicolic, paracolic, intermediate, and main lymph nodes, corresponding to D3-level lymph node dissection according to the General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum, and Anus in Japan.8 Cancers of the right colon was defined as located in the cecum, ascending colon, or hepatic flexure. The median age of the patients was 68 years (range, 34-92 years). The tumors were classified according to the TNM classification 9 as stage I in 32 patients (14.9%), stage II in 90 patients (41.9%), stage III cases in 76 patients (35.3%), and stage IV in 17 patients (7.9%). In the present series, standard lymph node dissection was also performed in selected patients with stage IV disease in combination with synchronous resection of a hepatic metastasis, or in patients who were candidates for hepatic and/or pulmonary metastatectomy after effective chemotherapy. We retrospectively analyzed the three-dimensional relations of the arteries directly originating from the SMA with the SMV based on operative findings that were prospectively recorded by ...

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 ).…”

Navigating the mesentery: a comparative pre‐ and per‐operative visualization of the vascular anatomy

“…Tajima et al [22] found a high rate (36%) of multiple middle colic arteries, more often double than triple. Our study confirms their latter finding but not the former.…”

Radiological and pathological evaluation of the level of arterial division after colon cancer surgery

“…The ileocolic artery often passes posteriorly to the superior mesocolic vein [22][23][24], which theoretically should result in a longer residual stump as a central tie is more difficult to achieve and surgeons often choose to divide the vessel after the crossing of the vein. In our series, the ileocolic artery passed posterior to the superior mesocolic vein in 69% of cases but surprisingly did not result in a longer stump length probably because the superior mesocolic vein was never exposed.…”