Clinical outcomes and radiological assessment of vascular anatomy in patients who underwent D3 left hemicolectomy

Abstract

Background. Adequate blood supply is one of the key factors for colorectal anastomosis healing. Various variants of vascular anatomy often come as a surprise to surgeons during operations. Objectives. The aims of this study were to carry out a comparative analysis of three-dimensional-computed tomography (3D-CT) angiography data with intraoperative data and a detailed analysis of variants of the anatomy of splenic flexure. Material and methods. In this study, we included 103 patients (56 males and 47 females; mean age 64.2 ± 11.6) with the left-sided colon and rectal cancer who underwent preoperative 3D-CT angiography at Ternopil University Hospital between 2016 and 2022. Results. According to the recently proposed classification, there are four types of blood supply to the splenic flexure of the colon: Our analysis showed that type 1 was found in 83 (80.6%) patients, type 2 in 9 (8.7%), type 3 in 10 (9.7%), and type 4 in 1 (1%). All patients underwent local left radical hemicolectomy with resection of complete mesocolic excision (CME), central vascular ligation (CVL) and resección (R0). Seven cases were operated laparoscopically; and the median quantity of removal lymph nodes was 21.54 ± 7.32. Positive lymph nodes were revealed in 24.3% cases. AL was diagnosed in one patient. Conclusions. Careful pre-operative analysis of vascular anatomy on 3D-CT angiography will assess the vascularization of the splenic flexure of the colon, reduce intraoperative time to identify structures, and develop a personalized strategy for surgery which potentially can reduce the risk of anastomotic leakage.