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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2018; 24(32): 3671-3676
Published online Aug 28, 2018. doi: 10.3748/wjg.v24.i32.3671
Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer
Ke-Xin Wang, Zhi-Qiang Cheng, Zhi Liu, Xiao-Yang Wang, Dong-Song Bi
Ke-Xin Wang, Zhi-Qiang Cheng, Zhi Liu, Xiao-Yang Wang, Dong-Song Bi, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Wang KX and Bi DS designed the study and wrote the manuscript; Wang KX and Liu Z instructed the whole study and prepared the figures; Wang KX and Wang XY collected and analyzed the data; Wang KX, Cheng ZQ, Liu Z, and Bi DS performed the operations; all authors have approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81471020; Shandong Medical and Health Technology Development Project, No. 2014WS0148; Qilu Hospital of Shandong University Scientific Research Funding, No. 2015QLMS32; and Shandong University Basic Scientific Research Funding (Qilu Hospital Clinical Research Project), No. 2014QLKY21.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Qilu Hospital of Shandong University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare there are no competing interests in this study.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The experimental method of this study was not a randomized controlled trial.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong-Song Bi, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan 250012, Shandong Province, China. bds20180512@sina.com
Telephone: +86-531-82165252 Fax: +86-531-82165252
Received: June 27, 2018
Peer-review started: July 2, 2018
First decision: July 11, 2018
Revised: July 17, 2018
Accepted: July 22, 2018
Article in press: July 21, 2018
Published online: August 28, 2018
Processing time: 61 Days and 22.7 Hours
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; Left colic artery; Rectal cancer; Laparoscopic

Core tip: One hundred and ten patients who underwent laparoscopic surgical resection with preservation of left colic artery (LCA) for rectal cancer were retrospectively reviewed. The 3D reconstruction of the vasculature was performed before surgical procedures. The types of branch vessels of inferior mesenteric artery (IMA) were classified. Furthermore, in the operations, relationships between the IMA, sigmoid artery (SA), LCA and superior rectal artery (SRA) were evaluated. The relationship between LCA and inferior mesenteric vein (IMV) was also evaluated. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels during laparoscopic radical resection of rectal cancer.