Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional
- PDF / 1,625,082 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 26 Downloads / 160 Views
ORIGINAL ARTICLE
Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography K. Iguchi 1 & H. Mushiake 1 & S. Hasegawa 1 & T. Fukushima 1 & M. Numata 2 & H. Tamagawa 2 & M. Shiozawa 3 & N. Yukawa 2 & Y. Rino 2 & M. Masuda 2 Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with colonography (3D-CTAC). Methods We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019. Results Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (N = 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (N = 26, 27.1%); (3A) the LMCA independently diverged from the SMA (N = 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (N = 3, 3.1%); (5A) only the AMCA and the LMCA was absent (N = 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (N = 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (N = 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (N = 3, 3.1%); (type 4V) the SFV is absent (N = 24, 25.0%). Conclusion 3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC. Keywords Colon cancer . Colorectal surgery . Colonography . Accessory middle colic artery . Splenic flexure . Splenic flexure vein
Introduction Surgery for colon carcinoma of the splenic flexure, otherwise known as splenic flexure cancer (SFC), requires special attention [1, 2]. This is because feeding arteries arise
* H. Mushiake [email protected] 1
Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Konandai, Konan-ku, Yokohama 234-0054, Japan
2
Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
3
Department of Colorectal Surgery, Kanagawa Cancer Center, Yokohama, Japan
from both the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) [3, 4]. Japanese D3 resection and European complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer are both based on oncologic principles. According to the principle of CME with CVL, lymph node dissection should be performed along with both arteries on SFC. Recently, another feeding artery toward the splenic flex
Data Loading...
