title: Technical difficulties of left colic artery preservation during left colectomy for colon cancer.
abstract: OBJECTIVE
  Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas.
  
  
  METHODS
  A vascular reconstruction computed tomography prospective series of 113 patients was analyzed. The inferior mesenteric artery (IMA) branching pattern according to Latarjet's classification (Type I, separate LCA origin, Type II, fan-shaped branching pattern) and the distances between the IMA and the LCA origins and between the LCA and the Inferior mesenteric vein (IMV) at the inferior border of the pancreas were measured.
  
  
  RESULTS
  The IMA branching pattern was Type I in 80 (71 %) patients and Type II in 33 (29 %) patients. The IMA-LCA distance was 39.8 ± 12.2 mm. The LCA-IMV distance at the inferior border of the pancreas was 20.5 ± 21.7 mm. When classified based on this distance, 75 (66 %) patients were classified into the Near subgroup (<20 mm) (7.7 ± 4.1 mm) and 38 (34 %) into the Far subgroup (≥20 mm) (45.6 ± 20.4 mm, p < 0.001). A Type I subgroup F accounted for 27 % of the patients.
  
  
  CONCLUSIONS
  Left colic artery preservation is highly feasible at its origin in more than two-thirds of cases due to the separate origin. The addition of a high IMV ligation increases the risk of damage to the LCA at the inferior border of the pancreas because the distance to the IMV is less than 20 mm in two-thirds of cases.
authors.affiliation: URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.|General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Patroni
authors.affiliation: Digestive Surgery Unit, Percy Military Hospital, Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonnet
authors.affiliation: Paris Descartes Faculty of Medicine, Paris, France.|Radiology Unit, Georges Pompidou AP-HP University Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourillon
authors.affiliation: URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.|General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bruzzi
authors.affiliation: General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.|Paris Descartes Faculty of Medicine, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Zinzindohoué
authors.affiliation: URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.|General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.|Paris Descartes Faculty of Medicine, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Chevallier
authors.affiliation: URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France. richard.douard@egp.aphp.fr.|General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France. richard.douard@egp.aphp.fr.|Paris Descartes Faculty of Medicine, Paris, France. richard.douard@egp.aphp.fr.
authors.forename: R
authors.initials: R
authors.lastname: Douard
authors.affiliation: General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, Paris, France.|Paris Descartes Faculty of Medicine, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging*; D008875:Middle Aged; D055815:Young Adult
keywords: CT scanner; Colorectal cancer; High-tie; Left colic artery; Left laparoscopic colectomy; Low-tie