Vascular Anatomy in Laparoscopic Colectomy for Right Colon Cancer.

Abstract

The vascular anatomy in the right colon varies; however, related studies are rare, especially on the laparoscopic vascular anatomy of living patients. The purpose of this study was to describe vascular variations around the gastrocolic trunk, middle colic vein, and ileocolic vessels in laparoscopic surgery for right-sided colon cancer. This is a retrospective descriptive study of patients undergoing laparoscopic colectomy for right colon cancer. The study was conducted at a single tertiary institution in Korea. Consecutive patients with right colon cancer who underwent laparoscopic right colectomy using the cranial-to-caudal approach (N = 116) between January 2014 and April 2015 were included. Three colorectal surgeons took photographs and videos of the vascular anatomy during each laparoscopic right colectomy, and these were analyzed for vascular variations. We classified venous variations around the gastrocolic trunk into 2 types (3 subtypes), type 1 (n = 92 (79.3%)), defined as 1 or 2 colic veins draining into the gastrocolic trunk, and type II (n = 24 (20.7%)), defined as having no gastrocolic trunk. We also investigated the tributaries of the superior mesenteric vein. One, 2, and 3 middle colic veins were found in 86 (74.1%), 26 (22.4%), and 4 patients (3.5%). The right colic vein drained directly into the superior mesenteric vein in 22 patients (19.0%). All of the patients had a single ileocolic vein draining into the superior mesenteric vein and a single ileocolic artery from the superior mesenteric artery. The right colic artery from the superior mesenteric artery was present in 38 patients (32.7%). The ileocolic artery passed the superior mesenteric vein anteriorly or posteriorly in 58 patients (50%) each. Unlike cadaver or radiological studies, we could not clarify the complete vessel paths. We classified vascular anatomic variations in laparoscopic colectomy for right colon cancer, which could be helpful for colorectal surgeons.