Multidisciplinary personalized approach to D3 lymph node dissection with preservation of left colic artery in patients with left sided colorectal cancer: surgical and radiological point of view.

BACKGROUND

Widely implemented in clinical practice 3D-CT angiography allows to conduct the analysis of vascular anatomy at the preoperative stage. The aim of this study was to carry out a detailed analysis of variants of the anatomy of the LCA, its relationship with the surrounding structures and to study the nuances that may complicate and increase the time of D3 lymph node dissection with preservation of LCA.

METHODS

In this study, we included 103 patients with left sided colon and rectal cancer who underwent preoperative 3D-CT angiography.

RESULTS

According to Zebrowski Classification, 8 most frequent variants of IMA branching patterns are allocated: type A (35 patients [34%]); type B (28 patients [27.2%]); type C (3 patients [2.9%]); type D (4 patients [3.9%]); type E (7 patients [6.8%]); type F (7 patients [6.8%]); type G (6 patients [5.8%]); and type H (13 patients [12.6%]). The average distance from the root of the IMA to the branch of the LCA was 35.29±10.18 mm (11-66 mm). There are 3 types of anatomical relationship between IMA-LCA-IMV system. Medial type was in 10 (9.7%) cases, lateral in 64 (62.1%), distal in 29 (28.2%). LCA intersects with the IMV at a distance of 20.97±13.59 mm (2-65) in patients with lateral and distal type.

CONCLUSIONS

Careful preoperative analysis of vascular anatomy will assess the difficulty of performing D3 lymph node dissection with LCA preservation. Moreover, it reduces the time during the operation to identify structures and to develop a personalized strategy for the operation.