Preoperative Evaluation of Blood Vessel Anatomy Using 3-Dimensional Computed Tomography for Laparoscopic Surgery of Transverse Colon Cancer

This study describes the efficacy of the evaluation of blood vessel anatomy by 3-dimensional computed tomography (3D-CT) for laparoscopic surgery for transverse colon cancer (TCC). A total of 102 patients with TCC were examined by preoperative 3D-CT to clarify their blood vessel anatomy at Tokyo Medical University Hospital between January 2010 and December 2015, before undergoing laparoscopic surgery using the obtained 3D-CT data. Regarding blood vessel variation, the middle colic artery (MCA) was present in all patients (100%). The common duct type was observed in 89 patients (87.3%), and a type of branch separate from the superior mesenteric artery was observed in 13 patients (12.7%). The accessory MCA was present in 25 patients (24.5%). The middle colic vein was present in all patients (100%), and it drained into the following vessels: the superior mesenteric vein, gastrocolic trunk, first jejunal vein, and inferior mesenteric vein [67 (65.8%), 25 (24.5%) 8 (7.8%), and 2 (1.9%) patients, respectively]. Regarding the surgical outcome, the bleeding volume was 43 g, the operative time was 218 minutes, the number of harvested lymph nodes was 21, the proximal resection margin was 164 mm, the distal resection margin was 105 mm, and the length of postoperative hospital stay was 10 days. Although complicated variations and anomalies in the MCA and the contiguous veins were observed, preoperative 3D-CT will be useful for surgeons performing laparoscopic surgery on patients with TCC.

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Preoperative Assessment of Vascular Anatomy by Multidetector Computed Tomography Before Laparoscopic Colectomy for Transverse Colon Cancer: Report of a Case

International Surgery ◽

10.9738/intsurg-d-13-00232.1 ◽

2015 ◽

Vol 100 (2) ◽

pp. 208-212 ◽

Cited By ~ 7

Author(s):

Aya Kawamoto ◽

Yasuhiro Inoue ◽

Masato Okigami ◽

Hiromi Yasuda ◽

Yoshinaga Okugawa ◽

...

Keyword(s):

Computed Tomography ◽

Colon Cancer ◽

Lymph Node ◽

Laparoscopic Surgery ◽

Lymph Node Dissection ◽

Transverse Colon ◽

Vascular Anatomy ◽

Preoperative Assessment ◽

Transverse Colon Cancer ◽

Node Dissection

Although the safety of laparoscopic surgery for colon cancer has been reported in many randomized controlled trials, concerns about the difficulty of surgery for transverse colon cancer has not been fully resolved, mainly because of the variation in the vascular anatomy of mesenteric vessels, which leads to difficulty in determining the optimal operative procedure and the extent of lymph node dissection. We present the case of a patient with transverse colon cancer who underwent laparoscopic surgery after preoperative assessment using a combination of endoscopic clipping and three-dimensional computed tomography angiography (3DCTA). A 68-year-old man was diagnosed with transverse colon cancer, and laparoscopic surgery has been planned. 3DCTA showed right-middle and left-middle colic arteries arising independently from the superior mesenteric artery. The relationship between the clip and vessels showed that the right-middle colic artery was the feeding artery of the tumor. Operative findings were consistent with 3DCTA findings, and transverse colectomy with lymph node dissection was successfully performed.

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