Abstract
BackgroundThis study aimed to analyze right colonic vascular variability.MethodsThe study included 60 consecutive patients who underwent laparoscopic radical right colectomy and D3 lymph node dissection for malignant colonic cancer on the ileocecal valve, ascending colon or hepatic flexure (March 2013 to October 2016). The videos of the 60 surgical procedures were collected. Variations of right colonic vascular anatomy were retrospectively analyzed based on 60 high-resolution surgical videos of laparoscopic surgery.ResultsThe superior mesenteric artery and vein were present in all cases; 95.0% (57/60) had the superior mesenteric artery on the left side of the superior mesenteric vein. The ileocolic artery and vein occurred in 96.7% (58/60) and 100% (60/60) of cases, respectively; 50.0% (29/58) had the ileocolic artery passing the superior mesenteric vein anteriorly. Thirty-three (55.0%) cases had a right colic artery, and 2 (3.33%) had a double right colic artery; 90.9% (30/36) had the right colic vein passing anterior to the superior mesenteric artery. Fifty-six (93.3%) cases had a right colic vein; 7 (12.5%) had a right colic vein accompanied by a right colic artery, 66.1% (37/56) had the right colic vein draining into the gastrocolic trunk of Henle, 23.2% (13/56) had the right colic vein directly draining into superior mesenteric vein, and 10.7% (6/56) had one right colic vein draining into the superior mesenteric vein and the other into the gastrocolic trunk of Henle. Fifty-three (88.3%) cases had a gastrocolic trunk of Henle: a gastrocolic trunk in 35.8% (19/53), a gastropancreatic trunk in 9.4% (5/53), and a gastropancreaticocolic trunk in 54.7% (29/53). The frequencies of middle colic artery and vein were respectively 100% (60/60) and 93.3% (56/60).ConclusionsRight colonic vascular variations were classified in Chinese patients. Notable findings included a superior mesenteric artery positioned to the right of the superior mesenteric vein and variation in middle colic artery length. This knowledge may be helpful to colorectal surgeons and could potentially help to improve safety by reducing vascular complications during minimally invasive procedures.
Highlights
This study aimed to analyze right colonic vascular variability
Consecutive patients were initially enrolled based on the following inclusion criteria: (1) malignant colonic neoplasm clinically or pathologically diagnosed before surgery; (2) tumor on the ileocecal valve, ascending colon or hepatic flexure; (3) laparoscopic radical right colectomy (LRRC) performed between March 2013 and October 2016; (4) standard D3 lymph node dissection undertaken according to the complete mesocolic excision principle
Among 7 cases with a double right colic vein, 6 (85.7%) had one right colic vein draining into the superior mesenteric vein and the other into the gastrocolic trunk of Henle, and 1 (14.3%) had a double right colic vein draining into the gastrocolic trunk of Henle; there were no instances of a double right colic vein draining into the superior mesenteric vein (Fig. 6)
Summary
This study aimed to analyze right colonic vascular variability. Laparoscopic right colectomy based on complete mesocolic excision [4, 5] increases the number of dissected lymph nodes, improves prognosis, and lowers local relapse [6, 7]. Wu et al World Journal of Surgical Oncology (2019) 17:16 right colon vascularity in Chinese people remain uncharacterized. We consider that a detailed knowledge of right colon vascular variations is important to improve safety and reduce the risks of vascular complications during minimally invasive surgery. This study aimed to retrospectively review high-resolution videos of laparoscopic radical right colectomy (LRRC) and explore right colon vascular variations in order to summarize the patterns of the variations and identify methods of coping with these variations during surgery. It was anticipated that our findings would provide a useful reference for surgeons
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