ReviewApplied vascular anatomy of the colon and rectum: Clinical implications for the surgical oncologist
Introduction
Radical surgical resection remains the basic method of treatment of many solid tumors, and offers the greatest chance for cure, especially when malignant disease has not disseminated. An in-depth knowledge of the anatomy is a basic requirement for the surgeon to optimize early and late results of surgery for malignant disease and to achieve not only low morbidity and mortality rates following even complicated surgical procedures, but also prolonged overall and disease-free survival, without recurrence of the tumor, thereby ameliorating patients’ quality-of-life.
Colorectal cancer represents the third most common type of cancer both in males as well as in females (excluding skin cancer); it accounts for 10% and for 11% of all types of cancers in men and women, respectively [1]. Colorectal cancer surgery represents a large part of the daily routine in many departments of surgery around the world. As is well known, the extent of surgical resection, but also the radicality in colorectal cancer surgery, specifically regarding the extent of lymphadenectomy, is closely related to vascular anatomy of the colon and rectum. Therefore, a thorough knowledge of the vascular anatomy of colon and rectum and the associated pattern of collateral variation is a mandatory prerequisite for colorectal resections. The aim of this work is to summarize and critically analyze currently available data regarding the vascular anatomy of the colon and rectum, from the perspective of a surgical oncologist.
Section snippets
Embryology
The formation of the aorta begins at the 3rd week of embryologic development, when two strands of cells migrate dorsally from the endocardial mesenchyme and elongate caudally along the neural groove to become the dorsal aortas. These two dorsal aortas remain separate from approximately 1 week but eventually fuse to form a single-aortic trunk that descends caudally. The mesenteric arteries originate from the primitive ventral segmental arteries. As development proceeds, there is regression of
Arteries supplying the colon
In the healthy state, the colon derives its blood supply from branches of the SMA and the IMA [2], [3], [4] (Fig. 1). The rectum and anal canal are supplied by branches of the IMA and the internal iliac arteries [4].
Comments
The exact extent of colonic resection is largely determined by the blood vessels that require division in order to remove the lymphatic drainage of the tumor-bearing part of the colon; the potential presence of nodal metastases requires high ligation of the arterial and venous supply of the colon [33]. The more radical the surgeon is in dealing with the lymphatic drainage, the greater the length of colon that will need to be resected [34]. There are few reports of controlled studies to assist
References (55)
- et al.
The mesenteric circulation. Anatomy and physiology
Surgical Clinics of North America
(1997) - et al.
Embryology, anatomy, and surgical exposure of the great abdominal vessels
Surgical Clinics of North America
(2000) - et al.
Vascular anatomy of the gastrointestinal tract
Best Practice and Research Clinical Gastroenterology
(2001) - et al.
Unusual causes of mesenteric ischemia
Surgical Clinics of North America
(1997) - et al.
Anatomy of the splanchnic circulation
Surgical Clinics of North America
(1992) Ischemic colitis
Surgical Clinics of North America
(1993)- et al.
Ischemic colitis
Surgical Clinics of North America
(1997) - et al.
Cancer Statistics 2006
CA Cancer Journal for Clinicians
(2006) - et al.
The mesenteric circulation
Surgical Clinics of North America
(1997) Langman's medical embryology
(1985)
Topographic anatomy
Surgical anatomy of the arterial supply of the colon from the superior mesenteric artery based upon a study of 600 specimens
Surgery Gynecology and Obstetrics
Blood supply of the large intestine: its surgical considerations
Archives of Surgery
Intestinal ischemia
The variant blood supply to the small and large intestines: Its importance in regional resections
Journal International College of the Surgeons
Vascular disease of the gastrointestinal tract: pathophysiology, recognition and management
Surgical anatomy and physiology of the colon, rectum, and anus
The variant blood supply to the descending colon, rectosigmoid, and rectum, based on 400 dissections
Disease of the Colon and Rectum
Anatomy of the small bowel, colon and rectum
The surgical anatomy of the rectal and anal blood vessels
Langenbecks Archives of Surgery
The arterial supply of the rectum and pelvic colon
British Journal of Surgery
The meandering mesenteric artery of the colon
AJR American Journal of Roentgenology
Surgical anatomy of the colon and rectum
Colon and rectum
Intestinal ischemia
A critical evaluation of selective celiac and superior mesenteric angiography
Radiology
Cited by (71)
Liposomic nano particles in the treatment of colorectal and ovarian cancer
2024, European Journal of Medicinal Chemistry ReportsConduit Selection for Reconstruction After Esophagectomy for Esophageal Cancer
2024, Surgical Oncology Clinics of North AmericaPrognostic score for synchronous metastatic rectal cancer: A real-world study
2023, Digestive and Liver DiseasePenis metastasis in colon cancer: A case report of an unusual site of dissemination
2023, International Journal of Surgery Case ReportsMRI of mesorectum and rectal cancer staging
2023, Magnetic Resonance Imaging of The Pelvis: A Practical ApproachThe marginal artery of Drummond revisited: A systematic review
2021, Translational Research in AnatomyCitation Excerpt :Through this arrangement, it supplies the splenic flexure and the transverse and sigmoid colons. In addition to the MA, there are several other main anastomoses within the abdominal viscera which provide collateral circulation: the pancreaticoduodenal arteries, which communicate with the celiac axis and the SMA and supply the pancreas and duodenum; the middle and left colic arteries, which communicate with the SMA and IMA and supply the descending and transverse colon, respectively; the numerous sigmoid arteries within the mesentery which anastomose the SMA and IMA and aid in supplying the descending and sigmoid colon; and the Arc of Riolan, which is located proximally to the MA and communicates with the SMA and IMA to aid in supplying the descending colon, sigmoid colon, and rectum [25,28]. Given the variable anatomy of the MA, it is not surprising that the vessels supplying it with blood are also varied.