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22.02.2018 | Original Article | Ausgabe 6/2018

International Journal of Colorectal Disease 6/2018

Retromesenteric course of the middle colic artery—challenges and pitfalls in D3 right colectomy for cancer

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 6/2018
Autoren:
Bojan V. Stimec, Bjarte T. Andersen, Stefan R. Benz, Jean H. D. Fasel, Knut M. Augestad, Dejan Ignjatovic

Abstract

Background

The middle colic artery (MCA) is of crucial importance in abdominal surgery, for laparoscopic or open right and transverse colectomies. Against this background, a high number of reports concerning anatomical variations of the MCA have been published intended to contribute to the improvement of operative techniques for the treatment of colon cancer. Despite this extensive literature, briefly reviewed in the present paper, a course of the MCA posterior to the superior mesenteric vein, called a retromesenteric trajectory, has been related to only once, to the best of our knowledge.

Methods

A total series of 507 patients included in two prospective trials concerning laparoscopic or open right colectomy for cancer between 2011 and 2017 are reported. The investigation included preoperative or postoperative multidetector-computed tomography angiography.

Results

We found four (0.79%) cases of retromesenteric MCA. They all underwent meticulous image analysis with mesenteric vessels’ road mapping, detailed morphometry, and surgical validation which revealed that, apart from their course, those cases did not differ significantly from the rest of the series.

Conclusion

This paper therefore documents the worth-knowing behavior causing considerable confusion for the operating surgeon unaware of the abnormality and shows its concrete impact on patient-tailored surgical practice, in particular for laparoscopic D3 colectomy (including the “uncinated process first” approach).

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Zusatzmaterial
Supplementary material 1. Case 1. 3D PDF of the STL file derived from 3D segmentation in Mimics. On the “Views” drop-down menu, select “Detailed view” for captions. (PDF 275 kb)
384_2018_2987_MOESM1_ESM.pdf
Supplementary material 2. Case 2. 3D PDF of the STL file derived from 3D segmentation in Mimics. On the “Views” drop-down menu, select “Detailed view” for captions. (PDF 542 kb)
384_2018_2987_MOESM2_ESM.pdf
Supplementary material 3. Case 3. 3D PDF of the STL file derived from 3D segmentation in Mimics. On the “Views” drop-down menu, select “Detailed view” for captions. (PDF 472 kb)
384_2018_2987_MOESM3_ESM.pdf
Supplementary material 4. Case 4. 3D PDF of the STL file derived from 3D segmentation in Mimics. On the “Views” drop-down menu, select “Detailed view” for captions. (PDF 333 kb)
384_2018_2987_MOESM4_ESM.pdf
Supplementary material 5. Case 4. Operation video, “Uncinate process first” approach (MP4 117 mb)
384_2018_2987_MOESM5_ESM.mp4
Literatur
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