Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

Wang, Kexin; Cheng, Zhiqiang; Li, Zhi; Wang, Xiaoyang; Bi, Dongsong

doi:10.3748/wjg.v24.i32.3671

Cited by 28 publications

(39 citation statements)

References 14 publications

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“…Wang et al [37] have performed a recent retrospective analysis of 110 patients undergoing rectal cancer surgery, with vascular reconstruction techniques prior to each procedure performed. The most common configuration they found was LCA arising independently from the IMA (46.4%), followed by LCA, SA and SRA branching simultaneously (30%) and LCA and SA branching from a common trunk of the IMA (23.6%).…”

Section: Branching Patterns Of the Inferior Mesenteric Arterymentioning

confidence: 99%

“…Wang et al [37] used a similar classification system to Yada et al's [38]; however, they named types 1, 2 and 3 as types A, B and C respectively. In type A, LCA arose independently from the IMA (46.4%), whilst in a type B, the LCA and SA branched from a common trunk of the IMA (23.6%).…”

Section: Classification Systems Of Imamentioning

confidence: 99%

“…Given the large amount of variability between classification systems available for the IMA system, the authors would propose a classification system that encompasses a number of key steps that surgeons and radiologists reviewing angiography should consider. The necessity of this is even more evident when viewing the classification systems proposed by Yada et al [38], Wang et al [21,37] and Miyamoto et al Each of these studies report very similar patterns of classifying the variations of the inferior mesenteric artery yet use different nomenclature. Importantly, the authors' proposed (Fig.…”

Section: Classification Systems Of Imamentioning

confidence: 99%

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A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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The objective of this review is to describe the normal and variant anatomy of the inferior mesenteric artery (IMA), including a brief overview of the relevant embryology, as well as proposing a classification system of the IMA vasculature, and clinical significance. A systematic review of articles published in Google Scholar and PubMed database using search terms: inferior mesenteric artery anatomy, inferior mesenteric artery variation, inferior mesenteric artery development, mesenteric circulation anatomy and variation, inferior mesenteric artery angiography. This was followed by review of the reference list of relevant publications to reveal publications missed during the initial search. Several standard anatomy and surgery text books were also referred for normal anatomy. The anatomy of the inferior mesenteric system is highly variant, with only a small proportion of anatomical, angiographic or surgical studies providing support for what is traditionally taught to be normal anatomy. Whilst the origin of the inferior mesenteric artery is less variant, the branching into left colic, sigmoidal and superior rectal arteries is variable between individuals in terms of origin of branches, number of branches and the presence or absence of certain branches. Whilst there did not appear to be a common classification system, similarities included three main variants of branching with a colosigmoid trunk, recto-sigmoid trunk or common trifurcation. There is a disparity between what is described in anatomical texts as the 'normal' IMA, and what is seen in anatomical, radiological and surgical research studies. The variable anatomy of the inferior mesenteric artery and its branches is significant in radiological interpretation and colorectal surgery from both an oncological perspective when considering resection, as well as in colonic ischaemia. A classification system has been introduced with a stepwise approach to the assessment of the IMA anatomy to avoid misleading nomenclature and provide a framework for surgeons to assess the vasculature.

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Section: Branching Patterns Of the Inferior Mesenteric Arterymentioning

confidence: 99%

Section: Classification Systems Of Imamentioning

confidence: 99%

Section: Classification Systems Of Imamentioning

confidence: 99%

See 1 more Smart Citation

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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“…The LT has shown a decrease in leakage with the comparable oncological outcome and 5-year long-term survival. 8 , 10 Chinese studies advocate preoperative 3D CT reconstruction to recognize variations 11 in the mesenteric artery and vein to preserve LCA and expertise in laparoscopic 12 procedure.…”

Section: Introductionmentioning

confidence: 99%

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Luo¹,

Yu²,

Huang³

et al. 2021

CMAR

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Background: Preservation of the left colic artery in low-tie (LT) of inferior mesenteric artery remains controversial compared to high-tie (HT) in the colon and rectal cancers, for lymph node dissection, anastomotic leakage, and oncological outcome. This cohort study aims to analyze short-and long-term outcomes of laparoscopic anterior resections in LT vs HT for rectal cancers. Methods: We analyzed a cohort of laparoscopic AR for RC from 2013 to 2016 at Renji Hospital, Shanghai, China. Short-and long-term outcome in LT vs HT group were compared for clinico-demographic characteristics, operative-time, lymph node dissection, short-term 30day outcome, and long-term 3-and 5-year overall survival as well as disease-free survival. The x 2 , t-test, and logistic regressions analysis were used and p<0.05 was considered significant. Results: The cohort consisted of 614 laparoscopic AR with LT (236) and HT (378). The clinicodemographic characteristics were comparable among the groups. The surgery took longer in LT. The yield of LND was similar. Leakage occurred in 12.21% (n=75). Leakage was fewer in LT than HT, 8.89% vs 14.28%, p=0.047. The postoperative severe complications were higher in HT. The 30-day mortality was nil. The long-term 3-and 5-year overall survival and disease-free survival were similar in LT and HT. Conclusion:The LT with preservation of left colic artery had similar lymph node yield, but lower leakage and complications than HT in laparoscopic anterior resections for rectal cancers. The long-term 3-and 5-year overall and disease-free survival were similar in the two groups.

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“…IMA IMA IMA AA AA LCA LCA LCA SA SA SA SRA SRA SRA AA as a common branch. In type 3, the left colic artery, sigmoid artery, and superior rectal artery branch simultaneously from the IMA [10][11][12]. The middle colic artery (MCA) plays a critical role in the blood supply of splenic flexure and originates from the superior mesenteric artery.…”

Section: Introductionmentioning

confidence: 99%

The importance of the Moskowitz artery as a lesser-known collateral pathway in the medial laparoscopic approach to splenic flexure mobilisation and its evaluation with preoperative computed tomography.

Karatay¹,

Javadov²

2020

Videosurgery and Other Miniinvasive Techniques

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Introduction The collateral pathways between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) play an important role in colonic surgery. The most well-known are the Drummond marginal artery and Riolan’s arch. The Moskowitz artery, also known as the meandering mesenteric artery, is a lesser-known collateral pathway and represents another link between SMA and IMA. The Moskowitz artery runs along the colonic mesentery floor and represents the link between the proximal segment of the middle colic artery and the ascending branch of the left colic artery. Aim To comprehend the presence and importance of the Moskowitz artery (meandering mesenteric artery) in preoperative patients by using computed tomography (CT) studies. Material and methods We retrospectively reviewed all abdominal CT images performed using intravenous contrast for any reason at the Radiology Department of Yeditepe University Hospital between April 2015 and September 2018. Patients older than 18 years with intravenous contrast (arterial and venous phases with a cross-section thickness of 0.625 mm), who underwent abdominal CT scan, and patients without any abdominal surgery were included in the study. As a result of the screening, 109 CT scans with eligibility criteria were included in this study. Results There were 109 cases in this study; 50 (45.9%) of them were male and 59 (54.1%) were female. Moskowitz artery was found in 18 (16.5%) cases; 8 were males and 10 were females. Riolan’s arch was present in 30 cases, of whom 15 were male and 15 were female. In our study Moskowitz artery and Riolan’s arch were monitored as separate vascular structures, and in all cases with Moskowitz artery, Riolan’s arch was also present. There was a statistically significant difference (p < 0.05) between the combined MCA emerging type and the presence of MA, and 12 cases with combined branch and 6 cases with single branch had Moskowitz artery. There was a statistically significant difference (p < 0.05) between LCA types and the presence of MA, and the Moskowitz artery was the most common seen at type 1 LCA. Conclusions Knowledge of the relationship between Riolan’s arch and the Moskowitz artery is valuable, and preoperative evaluation of this artery may be beneficial in the presence of Riolan’s arch. In addition, preoperative radiological evaluation and its importance are prominent in minimising intraoperative bleeding during splenic flexure mobilisation with a medial laparoscopic approach and reducing the risk of colorectal anastomosis leakage.

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Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

Cited by 28 publications

References 14 publications

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

The importance of the Moskowitz artery as a lesser-known collateral pathway in the medial laparoscopic approach to splenic flexure mobilisation and its evaluation with preoperative computed tomography.

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