Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

World J Gastroenterol. 2018 Aug 28;24(32):3671-3676. doi: 10.3748/wjg.v24.i32.3671.

Abstract

Aim: To investigate the vascular anatomy of inferior mesenteric artery (IMA) in laparoscopic radical resection with the preservation of left colic artery (LCA) for rectal cancer.

Methods: A total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery (SA) and superior rectal artery (SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein (IMV) and LCA was also evaluated.

Results: Three vascular types were identified in this study. In type A, LCA arose independently from IMA (46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA (23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location (30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases.

Conclusion: The vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.

Keywords: Inferior mesenteric artery; Laparoscopic; Left colic artery; Rectal cancer.

MeSH terms

  • Aged
  • Endoscopy, Digestive System / methods*
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Laparoscopy / methods*
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Lymphatic Metastasis
  • Male
  • Mesenteric Artery, Inferior / anatomy & histology*
  • Mesenteric Artery, Inferior / diagnostic imaging
  • Mesenteric Artery, Inferior / surgery
  • Mesenteric Veins / anatomy & histology
  • Middle Aged
  • Organ Sparing Treatments / methods
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / surgery*
  • Rectum / blood supply*
  • Rectum / diagnostic imaging
  • Rectum / pathology
  • Rectum / surgery
  • Retrospective Studies
  • Treatment Outcome