½Background: There are two approaches to CRC surgery: Eastern D3 lymphadenectomy and Western embryologically-oriented complete mesocolic excision with central vascular ligation (CME/CVL). The purpose of this article is to carry out a comparative analysis of 3-D CT angiography data with intra-operative data and to examine the variant anatomy of the right colic artery (RCA) and its significance in determining the extent of surgery in patients with right-sided CRC.
Methods: In this study, we included 103 patients (56 males and 47 females; mean age 64,2±11,6) with colorectal cancer who underwent preoperative 3D-CT angiography at Ternopil University Hospital between 2016 and 2021.
Results: All patients underwent local radical right hemicolectomy with CME, CVL and R0 resection; the median quantity of removal lymph nodes was 24,71±10,04 (range 46-83). Positive lymph nodes were revealed in 38,7 % of cases. The incidence of metastatic lymph nodes in the D1zone was 38.7%, the D2 zone - 3,2% and the zone D3 - 9,7%. According to our results - RCA classically deviated from SMA in 45 (43.7%) patients, in 25 (24.3%) patients RCA was absent, in 21 (20.4%) patients RCA deviated from ICA and in 12 (11.6%) of patients RCA deviated from MCA or DMCA (Fig. 1). Accordingly, in 58 (56.3%) patients it was either absent or was a non-independent branch of SMA.
Conclusions: Detailed preoperative analysis of 3D-CT angiography of each clinical case is a key point in the personalized assessment of vascular anatomy and can potentially assess the complexity of performing lymphadenectomy, reduce surgery time to identify structures, and develop a personalized surgery strategy.
Key words: 3D-CT angiography, right colic artery, D3 lymph node dissection, colorectal cancer
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