Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer.
To determine the indications for limited colon cancer surgery in each location, we reviewed the arterial branching patterns and lymph node metastases along the course of specific vascular trunks in 344 colon cancer patients who had undergone preoperative angiography and colectomy with lymph node dissection. Our conclusions are follows: Because the ileocecal artery always arises from the superior mesenteric artery and lymph node metastases of cecum cancer were limited to nodes along the ileocolic artery, cecum cancer can be cured by ileocecal resection. The right colic artery has various origins, and ascending colon cancer shows various patterns of lymph node metastases. Therefore a right hemicolectomy should be performed for ascending colon cancer. The middle colic artery forks into right and left branches, and each branch has different branching variations. If the right colic and middle colic arteries have a common trunk, a right hemicolectomy should be performed for transverse colon cancer on the right side. If the left branch of the middle colic artery has an independent replaced origin, lymph node dissection should be modified according to the variant origin. If the left colic artery and the first sigmoidal artery have a common trunk, the lymph nodes along the common trunk should be removed for sigmoid colon cancer and for descending colon cancer. Of the patients with sigmoid colon cancer, 6.3% also had lymph node metastases along the superior rectal artery. Given that the lymph nodes along the superior rectal artery are skeletonized, sigmoid colon cancer can be also cured by partial sigmoidectomy.
Yada
H
H
First Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto 602, Japan.
Sawai
K
K
Taniguchi
H
H
Hoshima
M
M
Katoh
M
M
Takahashi
T
T
D001158:Arteries / Q000033:anatomy & histology; D003106:Colon / Q000098:blood supply*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged