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Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with colonography (3D-CTAC).

Methods

We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019.

Results

Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (N = 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (N = 26, 27.1%); (3A) the LMCA independently diverged from the SMA (N = 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (N = 3, 3.1%); (5A) only the AMCA and the LMCA was absent (N = 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (N = 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (N = 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (N = 3, 3.1%); (type 4V) the SFV is absent (N = 24, 25.0%).

Conclusion

3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC.

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Data availability

All data analyzed during this study are included in this published article.

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Acknowledgments

The authors would like to express their heartfelt gratitude to all pathologists and radiologists at the Saiseikai Yokohamashi Nanbu Hospital who had always provided carefully considered and constructive feedback and valuable comments.

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Authors and Affiliations

  1. Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Konandai, Konan-ku, Yokohama, 234-0054, Japan

    K. Iguchi, H. Mushiake, S. Hasegawa & T. Fukushima

  2. Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan

    M. Numata, H. Tamagawa, N. Yukawa, Y. Rino & M. Masuda

  3. Department of Colorectal Surgery, Kanagawa Cancer Center, Yokohama, Japan

    M. Shiozawa

Authors
  1. K. Iguchi
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  2. H. Mushiake
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  3. S. Hasegawa
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  4. T. Fukushima
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  5. M. Numata
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  6. H. Tamagawa
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  7. M. Shiozawa
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  8. N. Yukawa
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  9. Y. Rino
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  10. M. Masuda
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Kenta Iguchi, Hiroyuki Mushiake, Seiji Hasegawa, and Tadao Fukushima. The first draft of the manuscript was written by Kenta Iguchi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to H. Mushiake.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval/consent to participate

This study was approved by the institutional review board of Saiseikai Yokohamashi Nanbu Hospital, and a written informed consent for the use of medical records was obtained from the patients (NANBU D-23). The study was conducted based on the ethical guidelines of the Declaration of Helsinki.

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Iguchi, K., Mushiake, H., Hasegawa, S. et al. Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography. Int J Colorectal Dis 36, 405–411 (2021). https://doi.org/10.1007/s00384-020-03773-x

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  • DOI: https://doi.org/10.1007/s00384-020-03773-x

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