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International Journal of Colorectal Disease

Erschienen in:

06.04.2019 | Original Article

Arterial anatomy of the splenic flexure using preoperative three-dimensional computed tomography

verfasst von: Tomoko Tanaka, Takeru Matsuda, Hiroshi Hasegawa, Kimihiro Yamashita, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji

Erschienen in: International Journal of Colorectal Disease | Ausgabe 6/2019

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Abstract

Background

To perform a safe and precise laparoscopic surgery for the splenic flexure cancer, it is important for surgeons to gain a preoperative understanding of the running of the feeding artery of the splenic flexure. We evaluated the blood supply to the splenic flexure by using preoperative three-dimensional computed tomography (3D-CT).

Method

We retrospectively analyzed a total of 88 patients with colorectal cancer who underwent preoperative 3D-CT at our institutions between April 2016 and June 2017.

Results

The arterial blood supply to the splenic flexure was divided into four patterns as follows: type 1, the left branch of the middle colic artery (MCA) with common trunk and the left colic artery (LCA) (n = 48, 54.5%); type 2, the left branch of the MCA with independent origin and the LCA (n = 8, 9.1%); type3, the accessory-MCA (A-MCA) and the LCA (n = 27, 30.7%); and type4, the LCA alone (n = 5, 5.7%). The MCA had the common trunk of the right and left branches in the majority of cases (85.2%). The right and left branches of the MCA arose separately from the superior mesenteric artery (SMA) in 8 of 88 patients (9.1%).

Conclusions

The arterial patterns of the splenic flexure were classified into four patterns by using preoperative 3D-CT. The A-MCA existed in 30% of the patients in this study. These information should be helpful to perform the optimal surgery for the splenic flexure cancer.

Ke J, Cai J, Wen X, Wu X, He Z, Zou Y, Qiu J, He X, He X, Lian L, Wu X, Zhou Z, Lan P (2017) Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: insights into rectal cancer surgery - a retrospective observational study. Int J Surg 41:106–111. https://doi.org/10.1016/j.ijsu.2017.03.012 CrossRefPubMed

Watanabe J, Ota M, Suwa Y, Ishibe A, Masui H, Nagahori K (2017) Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Color Dis 32(2):201–207. https://doi.org/10.1007/s00384-016-2669-4 CrossRef

Kawamoto A, Inoue Y, Okigami M, Yasuda H, Okugawa Y, Hiro J, Toiyama Y, Tanaka K, Uchida K, Mohri Y, Kusunoki M (2015) Preoperative assessment of vascular anatomy by multidetector computed tomography before laparoscopic colectomy for transverse colon cancer: report of a case. Int Surg 100(2):208–212. https://doi.org/10.9738/INTSURG-D-13-00232.1 CrossRefPubMedPubMedCentral

Matsuda T, Iwasaki T, Sumi Y, Yamashita K, Hasegawa H, Yamamoto M, Matsuda Y, Kanaji S, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y (2017) Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration. Int J Color Dis 32(1):139–141. https://doi.org/10.1007/s00384-016-2673-8 CrossRef

Ishikawa Y, Ehara K, Yamada T, Matsuzawa N, Arai S, Ban D, Kudo A, Tanabe M, Kawashima Y, Sakamoto H (2018) Three-dimensional computed tomography analysis of the vascular anatomy of the splenic hilum for gastric cancer surgery. Surg Today 48(9):841–847. https://doi.org/10.1007/s00595-018-1679-y CrossRefPubMed

Miyake H, Murono K, Kawai K, Hata K, Tanaka T, Nishikawa T, Otani K, Sasaki K, Kaneko M, Emoto S, Nozawa H (2018) Evaluation of the vascular anatomy of the left-sided colon focused on the accessory middle colic artery: a single-Centre study of 734 patients. Color Dis 20(11):1041–1046. https://doi.org/10.1111/codi.14287 CrossRef

Hirai K, Yoshinari D, Ogawa H, Nakazawa S, Takase Y, Tanaka K, Miyamae Y, Takahashi N, Tsukagoshi H, Toya H, Totsuka O, Sunose Y, Takeyoshi I (2013) Three-dimensional computed tomography for analyzing the vascular anatomy in laparoscopic surgery for right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 23(6):536–539. https://doi.org/10.1097/SLE.0b013e31828f66fb CrossRefPubMed

Matsuda T, Sumi Y, Yamashita K, Hasegawa H, Yamamoto M, Matsuda Y, Kanaji S, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y (2018) Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers. Surg Endosc 32(3):1202–1208. https://doi.org/10.1007/s00464-017-5792-6 CrossRefPubMed

Hamabe A, Park S, Morita S, Tanida T, Tomimaru Y, Imamura H, Dono K (2018) Analysis of the vascular interrelationships among the first Jejunal vein, the superior mesenteric artery, and the middle colic artery. Ann Surg Oncol 25(6):1661–1667. https://doi.org/10.1245/s10434-018-6456-z CrossRefPubMed

10.

Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tsugawa D, Sugita Y, Sumi Y, Shimada E, Kakeji Y (2015) Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery. Langenbeck's Arch Surg 400(1):113–117. https://doi.org/10.1007/s00423-014-1250-2 CrossRef

11.

Murono K, Kawai K, Ishihara S, Otani K, Yasuda K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Yamaguchi H, Watanabe T (2016) Evaluation of the vascular anatomy of the right-sided colon using three-dimensional computed tomography angiography: a single-center study of 536 patients and a review of the literature. Int J Color Dis 31(9):1633–1638. https://doi.org/10.1007/s00384-016-2627-1 CrossRef

12.

Ogino T, Takemasa I, Horitsugi G, Furuyashiki M, Ohta K, Uemura M, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M (2014) Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer. Ann Surg Oncol 21(Suppl 3):S429–S435. https://doi.org/10.1245/s10434-014-3572-2 CrossRefPubMed

13.

Fukuoka A, Sasaki T, Tsukikawa S, Miyajima N, Ostubo T (2017) Evaluating distribution of the left branch of the middle colic artery and the left colic artery by CT angiography and colonography to classify blood supply to the splenic flexure. Asian J Endosc Surg 10(2):148–153. https://doi.org/10.1111/ases.12349 CrossRefPubMed

14.

Mari FS, Nigri G, Pancaldi A, De Cecco CN, Gasparrini M, Dall'Oglio A, Pindozzi F, Laghi A, Brescia A (2013) Role of CT angiography with three-dimensional reconstruction of mesenteric vessels in laparoscopic colorectal resections: a randomized controlled trial. Surg Endosc 27(6):2058–2067. https://doi.org/10.1007/s00464-012-2710-9 CrossRefPubMed

15.

Sakorafas GH, Zouros E, Peros G (2006) Applied vascular anatomy of the colon and rectum: clinical implications for the surgical oncologist. Surg Oncol 15(4):243–255. https://doi.org/10.1016/j.suronc.2007.03.002 CrossRefPubMed

16.

Moghadamyeghaneh Z, Masoomi H, Mills SD, Carmichael JC, Pigazzi A, Nguyen NT, Stamos MJ (2014) Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS 18(4):e2014.00230. https://doi.org/10.4293/JSLS.2014.00230 CrossRefPubMedPubMedCentral

17.

Bhama AR, Wafa AM, Ferraro J, Collins SD, Mullard AJ, Vandewarker JF, Krapohl G, Byrn JC, Cleary RK (2016) Comparison of risk factors for unplanned conversion from laparoscopic and robotic to open colorectal surgery using the Michigan surgical quality collaborative (MSQC) database. J Gastrointest Surg 20(6):1223–1230. https://doi.org/10.1007/s11605-016-3090-6 CrossRefPubMed

18.

Rusu MC, Vlad M, Voinea LM, Curca GC, Sisu AM (2008) Detailed anatomy of a left accessory aberrant colic artery. Surg Radiol Anat 30(7):595–599. https://doi.org/10.1007/s00276-008-0362-1 CrossRefPubMed

19.

Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T (1997) Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg 21(1):109–115CrossRefPubMed

Titel: Arterial anatomy of the splenic flexure using preoperative three-dimensional computed tomography
verfasst von: Tomoko Tanaka
Takeru Matsuda
Hiroshi Hasegawa
Kimihiro Yamashita
Tetsu Nakamura
Satoshi Suzuki
Yoshihiro Kakeji
Publikationsdatum: 06.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 6/2019
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03289-z

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Arterial anatomy of the splenic flexure using preoperative three-dimensional computed tomography