A novel view on the variant anatomy of the inferior mesenteric artery in patients with colorectal cancer

• Voynovskiy A.E.
• Bashankaev B.N.
• Kirill I. Seurko
• Vinоkurоv I.A.

Abstract

Aim - to determine the anatomical features of structure of the inferior mesenteric artery (IMA) using MSCT.

Material and methods. 158 CT - studies of the abdominal cavity with intravenous contrast were analyzed from 2013 to 2020 year. Most patients (72.9%) underwent 3D-CT angiography using the computer tomography Siemens Somatom Sensation 64. To study of the vascular anatomy were used both a standard study and 3D-reconstruction.

Results. We proposed the classification of structure of the IMA and its branches. This is especially important when the safe lymph node dissection along the IMA is necessary. I type - several colonic branches derivate from the IMA by independent trunks (57%); II type - all colon branches derivate from the IMA in one point like a "goose paw" (25%); III type - one colon branch departs from the IMA by a single trunk; then it divides into colonic branches (18%).

Conclusion. CT with 3D-reconstruction of vessels allows the surgeon to perform an extended LND for colorectal cancer with a minimal risk of complications.

Keywords:CT-angiography, anatomical variations of the inferior mesenteric artery, resection of colon, colon cancer, left hemicolectomy

References

1.    Ansa B.E., Coughlin S.S., Alema-Mensah E., et al. Evaluation of colorectal cancer incidence trends in the United States (2000-2014). J Clin Med. 2018; 7 (22): 310-21.

2.    Tsar’kov P.V., Kravchenko A.Yu., Tulina I.A., Bashankayev B.N., Samofalova O.Yu., et al. Inferior mesenteric artery skeletization with paraaortic lymph-adenectomy in the treatment of left-sided colon cancer. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2012; 21 (2): 60-70. (in Russian)

3.    Khitar’yan A.G., Miziev I.A., Glumov E.E., Murly-chev A.S., Provotorov M.E., Kovalev S.A. Features of endovascular angioarchitectonics of the inferior mesenteric artery branches and their releavance to surgical colo-proctology. Annaly khirurgii [Annals of Surgery]. 2013; (6): 38-42. (in Russian)

4.    Corder A.P., Karanjia N.D., Williams J.D., Heald R.J. Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg. 1992; 79: 680-2.

5.    Bertrand M.M., Delmond L., Mazars R., Ripoche J., Macri F., Prudhomme M. Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches. Surg Radiol Anat. 2014; 36 (10): 1057-62.

6.    Chin C.C., Yeh C.Y., Tang R., Changchien C.R., Huang W.S., Wang J.Y. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 2008; 23: 783-8.

7.    Yada H., Sawai K., Taniguchi H., Hoshima M., Ka-toh M., Takahashi T. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg. 1997; 21: 109-15.

8.    Park M.G., Hur H., Min B.S., Lee K.Y., Kim N.K. Colonic ischemia following surgery for sigmoid colon and rectal cancer: a study of 10 cases and a review of the literature. Int J Colorectal Dis. 2012; 27: 671-5.

9.    Tsujinaka S., Kawamura Y.J., Tan K.Y., et al. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg. 2012; 101: 21-5.

10.    Tan K.Y., Kawamura YJ., Mizokami K., et al. Distribution of the first metastatic lymph node in colon cancer and its clinical significance. Colorectal Dis. 2010; 12 (1): 44-7.

11.    Veldkamp R., Kuhry E., Hop W.C., et al.; Colon Cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005; 6: 477-84.

12.    Van der Pas M.H., Haglind E., Cuesta M.A., et al.; Colorectal Cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013; 14: 210-8.

13.    Buunen M., Veldkamp R., Hop W.C., et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009; 10: 44-52.

14.    Tsujinaka S., Kawamura Y.J., Tan K.Y., et al. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg. 2012; 101: 21-5.

15.    Spasojevic M., Stimec B.V., Gronvold L.B., Nesgaard J.M., Edwin B., Ignjatovic D. The anatomical and surgical consequences of right colectomy for cancer. Dis Colon Rectum. 2011; 54: 1503-9.

16.    Zebrowski W., Augustyniak E., Zajac S. Variation of origin and branches of the inferior mesenteric artery and its anastomoses. Folia Morphol (Warsz). 1971; 30: 510-7.

17.    Bilhim T., Pereira J.A., Tinto H.R., et al. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat. 2013; 35: 517-22.

18.    Nicholas A., Michels M.A., Padmanabhan S., Paul L. The variant blood supply to the descending colon, rectosigmoid and rectum based on 400 dissections. Its importance in regional resections. A review of medical literature. Dis Colon Rectum. 1965; 8: 251-78.

19.    George R. Topography of the unpaired visceral branches of the abdominal aorta. J Anat. 1935; 69 (Pt 2): 196-205.

20.    Murono K., Kawai K., Kazama S., Ishihara S., Yamaguchi H., Sunami E., et al. Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography. Dis Colon Rectum. 2015; 58 (2): 214-9.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)