Personalized surgery for the splenic flexure cancer: new frontiers

作者：Bjarte Tidemann Andersen, Airazat М. Kazaryan, Bojan Vladimir Stimec, Bjørn Edwin, Peter Rancinger, Dejan Ignjatović · 发表于：British journal of surgery · 年份：2022 · DOI：10.1093/bjs/znac153 · 被引用次数：6 · 研究领域：Gastrointestinal Tumor Research and Treatment、Colorectal Cancer Surgical Treatments、Sarcoma Diagnosis and Treatment

Dear Editor Recent improvements in surgical techniques for colonic cancer have focused more on the mesentery than the colon itself1. Consequently, the mesenteric vascular anatomy is an area of interest to colorectal cancer surgeons. For embryological and, therefore, vascular anatomical reasons, patients with splenic flexure cancers present unique challenges. Awareness of the individual vascular anatomy before surgery can help to deliver patient-tailored and oncologically safe surgery. This report describes the detailed vascular anatomy of the splenic flexure. Data sets were derived from 32 preoperative CT images using three-dimensional (3D) reconstruction and 3D printing2. The middle colic artery (MCA) was constantly present, originating from the superior mesenteric artery (SMA) in all but one patient (3.1 per cent), in whom it originated from the inferior mesenteric artery (IMA). There was a wide range of MCA bifurcation positions. These can be classified into three groups: left of the superior mesenteric vein (SMV) (12.1 per cent), in front of the SMV (53.1 per cent), and right of the SMV (34.4 per cent). A longer MCA bifurcated over or right of the SMV, whereas a shorter one bifurcated left. The accessory MCA (aMCA) was found in 31.25 per cent of the patients. The aMCA originates cranial to the MCA from the SMA, its trajectory leading to the splenic flexure. In 50 per cent of patients in this study, the aMCA followed the lower border of the pancreas. This introduces anothe...