Abstract
BackgroundComplete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular tie and adherence to embryonic planes during dissection, supported by preoperative scanning to accurately define the tumour lymphovascular supply and drainage. The authors support and recommend precision oncosurgery based on these principles, with an emphasis on the importance of understanding the vascular anatomy. However, the anatomical variability of the right colic artery (RCA) has resulted in significant discord in the literature regarding its precise arrangement.MethodsWe systematically reviewed the literature on the incidence of the different origins of the RCA in cadaveric studies. An electronic search was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations up to October 2016 using the MESH terms ‘right colic artery’ and ‘anatomy’ (PROSPERO registration number CRD42016041578).ResultsTen studies involving 1073 cadavers were identified as suitable for analysis from 211 articles retrieved. The weighted mean incidence with which the right colic artery arose from other parent vessels was calculated at 36.8% for the superior mesenteric artery, 31.9% for the ileocolic artery, 27.7% for the root of the middle colic artery and 2.5% for the right branch of the middle colic artery. In 1.1% of individuals the RCA shared a trunk with the middle colic and ileocolic arteries. The weighted mean incidence of 2 RCAs was 7.0%, and in 8.9% of cadavers the RCA was absent.ConclusionsThis anatomical information will add to the technical nuances of precision oncosurgery in right-sided colon resections.
Highlights
Right hemicolectomy is the current operative standard for right-sided and transverse colon cancer [1, 2]
The ileocolic vessels are consistently ligated, but the same is not necessarily true of the right colic artery (RCA), a factor which the authors believe may lead to oncologically inferior outcomes
More recently some authors have begun to hone this classification by proposing that the term ‘right colic artery’ be reserved for a vessel arising independently from the superior mesenteric artery (SMA), whilst ‘right colic branch’ be applied in all other cases [11, 17]; this system is supported in the current review, owing to the high frequency with which the RCA arises from a vessel other than the SMA
Summary
Right hemicolectomy is the current operative standard for right-sided and transverse colon cancer [1, 2]. In the era of precision surgery, complete mesocolic excision (CME) is gathering favour as the procedure of choice for treating malignancy of the colon [5, 6]. The features of this technique include sharp dissection in the mesocolic plane, a high vascular tie of the feeding vessel (ensuring adequate horizontal length) and resection of the relevant lymphovascular package draining the tumour [7]. Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular tie and adherence to embryonic planes during dissection, supported by preoperative scanning to accurately define the tumour lymphovascular supply and drainage. Conclusions This anatomical information will add to the technical nuances of precision oncosurgery in right-sided colon resections
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
