A Patroni1,2, S Bonnet3, C Bourillon4,5, M Bruzzi1,2, F Zinzindohoué2,4, J M Chevallier1,2,4, R Douard6,7,8, A Berger2,4. 1. URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France. 2. General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France. 3. Digestive Surgery Unit, Percy Military Hospital, Clamart, France. 4. Paris Descartes Faculty of Medicine, Paris, France. 5. Radiology Unit, Georges Pompidou AP-HP University Hospital, Paris, France. 6. URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France. richard.douard@egp.aphp.fr. 7. General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France. richard.douard@egp.aphp.fr. 8. Paris Descartes Faculty of Medicine, Paris, France. richard.douard@egp.aphp.fr.
Abstract
PURPOSE: Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas. METHODS: A vascular reconstruction computed tomography prospective series of 113 patients was analyzed. The inferior mesenteric artery (IMA) branching pattern according to Latarjet's classification (Type I, separate LCA origin, Type II, fan-shaped branching pattern) and the distances between the IMA and the LCA origins and between the LCA and the Inferior mesenteric vein (IMV) at the inferior border of the pancreas were measured. RESULTS: The IMA branching pattern was Type I in 80 (71 %) patients and Type II in 33 (29 %) patients. The IMA-LCA distance was 39.8 ± 12.2 mm. The LCA-IMV distance at the inferior border of the pancreas was 20.5 ± 21.7 mm. When classified based on this distance, 75 (66 %) patients were classified into the Near subgroup (<20 mm) (7.7 ± 4.1 mm) and 38 (34 %) into the Far subgroup (≥20 mm) (45.6 ± 20.4 mm, p < 0.001). A Type I subgroup F accounted for 27 % of the patients. CONCLUSIONS: Left colic artery preservation is highly feasible at its origin in more than two-thirds of cases due to the separate origin. The addition of a high IMV ligation increases the risk of damage to the LCA at the inferior border of the pancreas because the distance to the IMV is less than 20 mm in two-thirds of cases.
PURPOSE: Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas. METHODS: A vascular reconstruction computed tomography prospective series of 113 patients was analyzed. The inferior mesenteric artery (IMA) branching pattern according to Latarjet's classification (Type I, separate LCA origin, Type II, fan-shaped branching pattern) and the distances between the IMA and the LCA origins and between the LCA and the Inferior mesenteric vein (IMV) at the inferior border of the pancreas were measured. RESULTS: The IMA branching pattern was Type I in 80 (71 %) patients and Type II in 33 (29 %) patients. The IMA-LCA distance was 39.8 ± 12.2 mm. The LCA-IMV distance at the inferior border of the pancreas was 20.5 ± 21.7 mm. When classified based on this distance, 75 (66 %) patients were classified into the Near subgroup (<20 mm) (7.7 ± 4.1 mm) and 38 (34 %) into the Far subgroup (≥20 mm) (45.6 ± 20.4 mm, p < 0.001). A Type I subgroup F accounted for 27 % of the patients. CONCLUSIONS: Left colic artery preservation is highly feasible at its origin in more than two-thirds of cases due to the separate origin. The addition of a high IMV ligation increases the risk of damage to the LCA at the inferior border of the pancreas because the distance to the IMV is less than 20 mm in two-thirds of cases.
Entities:
Keywords:
CT scanner; Colorectal cancer; High-tie; Left colic artery; Left laparoscopic colectomy; Low-tie
Authors: Johan F Lange; Niels Komen; Germaine Akkerman; Erik Nout; Herman Horstmanshoff; Frans Schlesinger; Jaap Bonjer; Gerrit-Jan Kleinrensink Journal: Am J Surg Date: 2007-06 Impact factor: 2.565
Authors: S Bonnet; A Berger; N Hentati; B Abid; J-M Chevallier; P Wind; V Delmas; R Douard Journal: Dis Colon Rectum Date: 2012-05 Impact factor: 4.585