Preoperative Computed Tomography Colonography-Angiography for Vascular Mapping to Guide and Standardize D3 Lymphadenectomy in Right-Sided and Transverse Colon Cancer
{"title":"Preoperative Computed Tomography Colonography-Angiography for Vascular Mapping to Guide and Standardize D3 Lymphadenectomy in Right-Sided and Transverse Colon Cancer","authors":"Takeharu Kato, Yukihide Kanemitsu, Mototaka Miyake, Gen Tomizawa, Kohei Takura, Hiroshi Nagata, Yasuyuki Takamizawa, Konosuke Moritani, Shunsuke Tsukamoto","doi":"10.1002/ags3.70215","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>In right hemicolectomy (RHC) and left-sided transverse colectomy (TC), D3 lymph node dissection is oncologically significant but technically demanding because of marked vascular variability. Standardization requires reliable preoperative anatomical assessment. We evaluated colic vascular anatomy and quantified D3 dissection distance using computed tomography colonography-angiography (CTC-A).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively analyzed 591 patients with primary right or transverse colon cancer who underwent preoperative CTC-A during 2014–2023. Arterial origins, venous drainage, and positional relationships around the superior mesenteric artery (SMA) and vein (SMV) were classified. After excluding aberrant cases, branching patterns relevant to D3 dissection were categorized and D3 distances measured along the SMA centerline using curved planar reformation images.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>An accessory middle colic artery (aMCA) was present in 38.1% of patients (SMA-derived, 76.4%). The MCA originated as a common trunk in 77.8% and as independent branches in 19.0%. The right colic artery (RCA) was observed in 41.8%. Four reproducible vascular patterns each were identified for RHC and TC. In RHC (<i>n</i> = 490), independent-origin MCA was consistently associated with shorter D3 distances (RCA-present, 22.5 vs. 27.5 mm, <i>p</i> = 0.012; RCA-absent, 16.5 vs. 20.5 mm, <i>p</i> < 0.001). In TC (<i>n</i> = 524), the aMCA originated dorsal to the pancreas in ~23%, and D3 distance was shorter in aMCAs with an independent-origin MCA (18.0 vs. 25.0 mm, <i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>High-resolution CTC-A yielded a single-modality, operation-oriented mapping integrating tumor location with mesenteric arteriovenous anatomy. Pattern-based classification and objective D3 distance estimation may support preoperative planning and help establish standardized, safer D3 lymphadenectomy for right-sided and transverse colon cancer.</p>\n </section>\n </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"10 4","pages":"1120-1132"},"PeriodicalIF":3.2000,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.70215","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterological Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ags3.70215","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/4/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
In right hemicolectomy (RHC) and left-sided transverse colectomy (TC), D3 lymph node dissection is oncologically significant but technically demanding because of marked vascular variability. Standardization requires reliable preoperative anatomical assessment. We evaluated colic vascular anatomy and quantified D3 dissection distance using computed tomography colonography-angiography (CTC-A).
Methods
We retrospectively analyzed 591 patients with primary right or transverse colon cancer who underwent preoperative CTC-A during 2014–2023. Arterial origins, venous drainage, and positional relationships around the superior mesenteric artery (SMA) and vein (SMV) were classified. After excluding aberrant cases, branching patterns relevant to D3 dissection were categorized and D3 distances measured along the SMA centerline using curved planar reformation images.
Results
An accessory middle colic artery (aMCA) was present in 38.1% of patients (SMA-derived, 76.4%). The MCA originated as a common trunk in 77.8% and as independent branches in 19.0%. The right colic artery (RCA) was observed in 41.8%. Four reproducible vascular patterns each were identified for RHC and TC. In RHC (n = 490), independent-origin MCA was consistently associated with shorter D3 distances (RCA-present, 22.5 vs. 27.5 mm, p = 0.012; RCA-absent, 16.5 vs. 20.5 mm, p < 0.001). In TC (n = 524), the aMCA originated dorsal to the pancreas in ~23%, and D3 distance was shorter in aMCAs with an independent-origin MCA (18.0 vs. 25.0 mm, p < 0.001).
Conclusions
High-resolution CTC-A yielded a single-modality, operation-oriented mapping integrating tumor location with mesenteric arteriovenous anatomy. Pattern-based classification and objective D3 distance estimation may support preoperative planning and help establish standardized, safer D3 lymphadenectomy for right-sided and transverse colon cancer.
背景：在右侧半结肠切除术（RHC）和左侧横结肠切除术（TC）中，D3淋巴结清扫具有重要的肿瘤学意义，但由于明显的血管变异性，在技术上要求很高。标准化需要可靠的术前解剖评估。我们使用计算机断层结肠镜血管造影（CTC-A）评估结肠血管解剖并量化D3夹层距离。方法回顾性分析2014-2023年间591例术前行CTC-A的原发性右结肠癌或横断面结肠癌患者。动脉起源，静脉引流，以及肠系膜上动脉（SMA）和静脉（SMV）周围的位置关系进行分类。在排除异常病例后，对与D3解剖相关的分支模式进行分类，并利用曲面重构图像沿SMA中心线测量D3距离。结果38.1%的患者存在副结肠中动脉（aMCA），其中sma源性占76.4%。MCA以共同主干的形式出现的占77.8%，以独立分支的形式出现的占19.0%。右结肠动脉（RCA）占41.8%。RHC和TC各鉴定出四种可重复的血管模式。在RHC （n = 490）中，独立起源的MCA始终与较短的D3距离相关（rca存在，22.5 vs. 27.5 mm, p = 0.012； rca不存在，16.5 vs. 20.5 mm, p < 0.001）。在TC （n = 524）中，约23%的aMCA起源于胰腺背侧，具有独立起源MCA的aMCA的D3距离较短（18.0比25.0 mm, p < 0.001）。结论高分辨率CTC-A可将肿瘤定位与肠系膜动静脉解剖相结合，形成单模态、手术导向的作图。基于模式的分类和客观的D3距离估计可以支持术前计划，并有助于建立标准化、更安全的右侧和横断面结肠癌D3淋巴结切除术。
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
