Real-time intraoperative anatomy study of 200 cases of superior mesenteric vessels and its tributaries: A single-center prospective cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Kexuan , LI Hongbo , LU Junyang , XU Lai , ZHANG Guannan , SUN Zhen ,  XIAO Yi

Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

XIAO Yi, Email: xiaoy@pumch.cn

Keywords：

mesenteric superior artery; mesenteric superior vein; anatomy; complete mesocolon excision; laparoscopic right hemicolectomy

DOI：

10.7507/1007-9424.202407027

Video：

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Objective To explore the prevalence and adjacency of the tributaries of superior mesenteric vessel. Methods This study is a prospective study. The patients with right-sided colonic malignant tumor who underwent laparoscopic complete mesocolon excision at the Division of Colorectal Surgery of Peking Union Medical College Hospital from July 2016 to September 2022 were collected. The real-time observation and evaluation of vascular anatomy was performed by the operator and recorded by a resident. The continuous variables without a normal distribution were summarized as median (P₂₅, P₇₅). The categorical variables were presented as number (%). Results A total of 200 patients were enrolled, including 114 males and 86 females, with an age of 63.5 (53.5, 72.0) years. The prevalence of ileocolic artery and vein was 98.0% (196/200) and 98.5% (197/200), respectively. There were 168 (86.2%) cases of the ileocolic vein accompanied the course of the ileocolic artery at the origin in 195 patients with simultaneous presence of ileocolic artery and vein. The right colic artery and vein was present in 39.5% (79/200) and 18.5% (37/200) patients, respectively. The prevalence of the middle colic artery and vein was 96.5% (193/200) and 90.5% (181/200), respectively. And the prevalence of the middle colic vein accompanied the path of the middle colic artery at the root was 67.8% (118/174) in the 174 patients with simultaneous presence of middle colic artery and vein. The trunk length of the middle colic artery was 2.2 (1.6, 3.2) cm. The Henle trunk was present in 185 (92.5%) cases, with a trunk length of 1.00 (0.50, 1.40) cm, and its lower edge was 2.80 (2.20, 3.30) cm from the junction of the pancreatic head and the horizontal part of the duodenum.Conclusions The results from the data analysis of this study suggest that the ileocolic artery and vein are present most constantly with a high incidence of the ileocolic vein accompanied the course of the ileocolic artery at the origin of superior mesenteric vessels. Therefore ileocolic artery and vein are expected to serve as an optimal anatomical landmarks for the caudal-to-cranial medial approach in laparoscopic complete mesocolon excision.

Citation： LI Kexuan, LI Hongbo, LU Junyang, XU Lai, ZHANG Guannan, SUN Zhen, XIAO Yi. Real-time intraoperative anatomy study of 200 cases of superior mesenteric vessels and its tributaries: A single-center prospective cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(1): 83-87. doi: 10.7507/1007-9424.202407027 Copy

1.	Bertelsen CA, Neuenschwander AU, Jansen JE, et al. 5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol, 2019, 20(11): 1556-1565.
2.	Xu L, Su X, He Z, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol, 2021, 22(3): 391-401.
3.	Kuzu MA, İsmail E, Çelik S, et al. Variations in the vascular anatomy of the right colon and implications for right-sided colon surgery. Dis Colon Rectum, 2017, 60(3): 290-298.
4.	Murono K, Kawai K, Ishihara S, et al. Evaluation of the vascular anatomy of the right-sided colon using three-dimensional computed tomography angiography: a single-center study of 536 patients and a review of the literature. Int J Colorectal Dis, 2016, 31(9): 1633-1638.
5.	Gamo E, Jiménez C, Pallares E, et al. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg Radiol Anat, 2016, 38(5): 519-527.
6.	Nesgaard JM, Stimec BV, Bakka AO, et al. Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis, 2015, 17(9): 810-818.
7.	Alsabilah J, Kim WR, Kim NK. Vascular structures of the right colon: Incidence and variations with their clinical implications. Scand J Surg, 2017, 106(2): 107-115.
8.	Lee SJ, Park SC, Kim MJ, et al. Vascular anatomy in laparoscopic colectomy for right colon cancer. Dis Colon Rectum, 2016, 59(8): 718-724.
9.	肖毅, 陆君阳, 徐徕, 等. 肠系膜上血管系统解剖特点的临床研究. 中华外科杂志, 2019, 57(9): 673-680.
10.	谢忠士. 腹腔镜右半结肠切除手术入路演变. 中国实用外科杂志, 2023, 43(10): 1133-1136.
11.	Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc, 2004, 18(8): 1163-1185.
12.	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
13.	Negoi I, Beuran M, Hostiuc S, et al. Surgical anatomy of the superior mesenteric vessels related to colon and pancreatic surgery: A systematic review and meta-analysis. Sci Rep, 2018, 8(1): 4184. doi: 10.1038/s41598-018-22641-x.
14.	Enomoto M, Katsumata K, Kasahara K, et al. Laparoscopic middle colic artery-preserved right hemicolectomy with true D3 lymph node dissection for right-sided colon cancer: modified complete mesocolic excision. Surg Endosc, 2021, 35(5): 2386-2388.
15.	Zou J, Jiang X, Cao W, et al. Terminal reaches of the branches from middle colic artery and their correlation with right colic artery. Indian J Surg, 2023, 85(1): 51-57.
16.	Ushijima H, Kawamura J, Ueda K, et al. Visualization of lymphatic flow in laparoscopic colon cancer surgery using indocyanine green fluorescence imaging. Sci Rep, 2020, 10(1): 14274. doi: 10.1038/s41598-020-71215-3.
17.	Freund MR, Edden Y, Reissman P, et al. Iatrogenic superior mesenteric vein injury: the perils of high ligation. Int J Colorectal Dis, 2016, 31(9): 1649-1651.
18.	郑民华, 马君俊. 腹腔镜结直肠手术手术入路选择专家共识. 中国实用外科杂志, 2017, 37(4): 415-419.
19.	Yada H, Sawai K, Taniguchi H, et al. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg, 1997, 21(1): 109-115.
20.	肖毅, 陆君阳, 徐徕. 肠系膜上血管及其属支临床解剖研究. 中国实用外科杂志, 2017, 37(4): 420-424.

1. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. 5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol, 2019, 20(11): 1556-1565.
2. Xu L, Su X, He Z, et al. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol, 2021, 22(3): 391-401.
3. Kuzu MA, İsmail E, Çelik S, et al. Variations in the vascular anatomy of the right colon and implications for right-sided colon surgery. Dis Colon Rectum, 2017, 60(3): 290-298.
4. Murono K, Kawai K, Ishihara S, et al. Evaluation of the vascular anatomy of the right-sided colon using three-dimensional computed tomography angiography: a single-center study of 536 patients and a review of the literature. Int J Colorectal Dis, 2016, 31(9): 1633-1638.
5. Gamo E, Jiménez C, Pallares E, et al. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg Radiol Anat, 2016, 38(5): 519-527.
6. Nesgaard JM, Stimec BV, Bakka AO, et al. Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis, 2015, 17(9): 810-818.
7. Alsabilah J, Kim WR, Kim NK. Vascular structures of the right colon: Incidence and variations with their clinical implications. Scand J Surg, 2017, 106(2): 107-115.
8. Lee SJ, Park SC, Kim MJ, et al. Vascular anatomy in laparoscopic colectomy for right colon cancer. Dis Colon Rectum, 2016, 59(8): 718-724.
9. 肖毅, 陆君阳, 徐徕, 等. 肠系膜上血管系统解剖特点的临床研究. 中华外科杂志, 2019, 57(9): 673-680.
10. 谢忠士. 腹腔镜右半结肠切除手术入路演变. 中国实用外科杂志, 2023, 43(10): 1133-1136.
11. Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc, 2004, 18(8): 1163-1185.
12. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
13. Negoi I, Beuran M, Hostiuc S, et al. Surgical anatomy of the superior mesenteric vessels related to colon and pancreatic surgery: A systematic review and meta-analysis. Sci Rep, 2018, 8(1): 4184. doi: 10.1038/s41598-018-22641-x.
14. Enomoto M, Katsumata K, Kasahara K, et al. Laparoscopic middle colic artery-preserved right hemicolectomy with true D3 lymph node dissection for right-sided colon cancer: modified complete mesocolic excision. Surg Endosc, 2021, 35(5): 2386-2388.
15. Zou J, Jiang X, Cao W, et al. Terminal reaches of the branches from middle colic artery and their correlation with right colic artery. Indian J Surg, 2023, 85(1): 51-57.
16. Ushijima H, Kawamura J, Ueda K, et al. Visualization of lymphatic flow in laparoscopic colon cancer surgery using indocyanine green fluorescence imaging. Sci Rep, 2020, 10(1): 14274. doi: 10.1038/s41598-020-71215-3.
17. Freund MR, Edden Y, Reissman P, et al. Iatrogenic superior mesenteric vein injury: the perils of high ligation. Int J Colorectal Dis, 2016, 31(9): 1649-1651.
18. 郑民华, 马君俊. 腹腔镜结直肠手术手术入路选择专家共识. 中国实用外科杂志, 2017, 37(4): 415-419.
19. Yada H, Sawai K, Taniguchi H, et al. Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg, 1997, 21(1): 109-115.
20. 肖毅, 陆君阳, 徐徕. 肠系膜上血管及其属支临床解剖研究. 中国实用外科杂志, 2017, 37(4): 420-424.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Real-time intraoperative anatomy study of 200 cases of superior mesenteric vessels and its tributaries: A single-center prospective cohort study

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