Anatomical variations in right colon vascularization and its implication in complete mesocolic excision with D3 lymphadenectomy

A cross-sectional study

Abstract

BACKGROUND:

Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications.

AIM:

Primary outcome was to determine the prevalence of anatomical variations of the SMA and its branches in relation to the SMV. Secondary outcome was to evaluate the association between these anatomical varitions and sex and ethnicity of the patients.

DESIGN:

Cross-sectional study

METHODS:

130 patients with right colon cancer diagnosed between January and December 2019 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 (1a–c; 2a–c), according to the relationship of the SMA and its branches with the SMV.

RESULTS:

The ileocolic artery was constant, crossing the SMV posteriorly in 61.5% of the cases. The right colic artery, present in 55.4% of the patients, crossed the SMV on its anterior side in 95.8% of the cases. The most frequent subgroup variant was 2c followed by 2a (34.6% and 25.4%, respectively). No association was found between anatomical variants and gender or ethnic origin.

CONCLUSIONS

The anatomical variations of the SMA and its branches are common with no predominant pattern. There was no association between them and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angiography is useful to avoid vascular injuries during CME-D3.