Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
Updates Surg. 2024 Jun;76(3):933-941. doi: 10.1007/s13304-024-01787-6. Epub 2024 Mar 25.
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
结直肠癌是全球第三大常见癌症,影响 40-45%的右半结肠癌患者。手术,特别是腹腔镜和机器人手术等微创方法,是首选的治疗方法。然而,这些技术存在技术并发症。解剖复杂性和血管分支模式的变化带来了挑战,特别是对于经验不足的外科医生。CoDIG 2 是一项全国性的观察性研究,涉及 76 个专注于结直肠手术的意大利普通外科专科中心。这些中心被要求保持其标准的外科和临床实践。本研究旨在分析接受腹腔镜右半结肠切除术的意大利患者的术中血管解剖结构,并探讨意大利外科医生使用的结扎技术。外科医生报告了 616 例患者右结肠血管化和 368 例患者 RCA 手术解剖的信息。53 例患者(10.8%)术中未发现 RCA。在评估过程中,右结肠动脉(RCA)根据 Yada 分类(类型 1-4)进行分类,术中评估显示 Yada 类型 1最常见(55.2%),而影像学评估显示类型 2更为常见。此外,与肠系膜上静脉(SMV)相比,RCA 根据术中和增强 CT 检查更常位于前位;术中检查发现 59.9%位于前位,而术前增强 CT 检查发现 40.1%位于同一位置。右结肠的血管化,包括缺失分支、额外分支、共同干和肠系膜静脉的后上走行,表现出明显的变化。为了了解血管变异,术前需要进行影像学研究;尽管术中评估与影像学评估之间没有一致性,但这是术前介入放射学评估(PII)的局限性,因为它总是需要进行肿瘤分期。对于经验不足的外科医生来说,这种方法尤其重要,可以避免潜在的并发症,如出血问题。