Abstract
The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.
Highlights
Understanding the complex tridimensional anatomy of the superior mesenteric vein (SMV) and artery (SMA) is of paramount importance to minimize the iatrogenic injuries during modern radical resections for right colon cancers or surgical resection of tumors located in the uncinate process of the pancreas[12,13,14]
The objective of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, resulted from meta-analysis of the existing evidence, with impact in colon and pancreatic resections
The superior mesenteric vessels and their branches were investigated by dissections of cadaveric specimens in 21 studies[15,16,22,23,24,25,26,27,29,38,39,44,45,49,52,54,55,56,57,58,59], by imaging methods in 16 studies (CT − 13 studies[18,21,28,32,33,34,35,37,40,43,50,51,53], MRI – one study[41], Cadaveric and Imagistic (CT) and surgery – one study[20], Angiography – one study46), and by dissection during surgical procedures in eight studies
Summary
Understanding the complex tridimensional anatomy of the superior mesenteric vein (SMV) and artery (SMA) is of paramount importance to minimize the iatrogenic injuries during modern radical resections for right colon cancers or surgical resection of tumors located in the uncinate process of the pancreas[12,13,14]. Standard textbooks of surgery are schematic, often contradictory, and do not offer the required anatomical details for one who embark on refined techniques such as CME-CVL, D3 lymphadenectomy for right colon cancers or pancreatic resections www.nature.com/scientificreports/. A comprehensive knowledge of the infra-pancreatic SMV and SMA surgical anatomy is required. The objective of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, resulted from meta-analysis of the existing evidence, with impact in colon and pancreatic resections
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