Abstract
PurposeIn the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns.MethodsWe included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery.ResultsAccessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases.Conclusion3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.
Highlights
In colorectal cancer surgery, it is essential to dissect the regional lymph nodes to an extent proportional to the stage of the tumor being resected [29]
We reconstructed the main trunk of the inferior mesenteric veins and fused them with the artery images; we sought to find the frequency with which an artery accompanies the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery
We investigated which artery accompanied it. This was defined as an artery that passed caudally to the lower margin of the pancreas to the distal transverse colon, and its presence was observed in 48.9% of cases (70/143)
Summary
It is essential to dissect the regional lymph nodes to an extent proportional to the stage of the tumor being resected [29]. It is exceedingly important to identify the feeding vessels of the tumor so that the region to be dissected can be determined. The use of laparoscopic navigation in colorectal cancer has been increasing in recent years with the popularization of laparoscopic surgery. We believe that in order to perform colorectal cancer surgery safely and effectively with curative intent, it is extremely important to determine the arterial branching pattern before commencing surgery. With the rapid progress in high-speed, high-resolution computed tomography (CT) technology and image reconstruction software, it is possible to quickly see the branching patterns of arteries while keeping invasiveness to a minimum. The superior mesenteric artery, the inferior mesenteric artery, and the vessels supplying the colon and rectum have various
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