Abstract Background. Adequate blood supply is one of the key factors for colorectal anastomosis healing. Various variants of vascular anatomy often come as a surprise to surgeons during operations. Objectives. The aims of this study were to carry out a comparative analysis of three-dimensional-computed tomography (3D-CT) angiography data with intraoperative data and a detailed analysis of variants of the anatomy of splenic flexure. Material and methods. In this study, we included 103 patients (56 males and 47 females; mean age 64.2 ± 11.6) with the left-sided colon and rectal cancer who underwent preoperative 3D-CT angiography at Ternopil University Hospital between 2016 and 2022. Results. According to the recently proposed classification, there are four types of blood supply to the splenic flexure of the colon: Our analysis showed that type 1 was found in 83 (80.6%) patients, type 2 in 9 (8.7%), type 3 in 10 (9.7%), and type 4 in 1 (1%). All patients underwent local left radical hemicolectomy with resection of complete mesocolic excision (CME), central vascular ligation (CVL) and resección (R0). Seven cases were operated laparoscopically; and the median quantity of removal lymph nodes was 21.54 ± 7.32. Positive lymph nodes were revealed in 24.3% cases. AL was diagnosed in one patient. Conclusions. Careful pre-operative analysis of vascular anatomy on 3D-CT angiography will assess the vascularization of the splenic flexure of the colon, reduce intraoperative time to identify structures, and develop a personalized strategy for surgery which potentially can reduce the risk of anastomotic leakage.

Resumen Antecedentes. El suministro de sangre adecuado es uno de los factores clave para la curación de la anastomosis colorrectal. Varias variantes de la anatomía vascular a menudo sorprenden a los cirujanos durante las operaciones. Objetivo. Realizar un análisis comparativo de los datos de la angiografía tridimensional por tomografía computarizada (3D-TC) con los datos intraoperatorios y un análisis detallado de las variantes de la anatomía del ángulo esplénico. Método. Se incluyeron en el estudio 103 pacientes con cáncer de colon y recto del lado izquierdo que se sometieron a una angiografía 3D-TC preoperatoria en el Hospital Universitario de Ternopil. Resultados. De acuerdo con la clasificación propuesta recientemente, existen cuatro tipos de irrigación del ángulo esplénico del colon. Nuestro análisis mostró que el tipo 1 se encontró en 83 (80.6%) pacientes, el tipo 2 en 9 (8.7%), el tipo 3 en 10 (9.7%) y el tipo 4 en 1 (1%). Todos los pacientes fueron sometidos a hemicolectomía radical izquierda local con resección de escisión mesocólica completa (CME), ligadura vascular central (CVL) y resección (R0). Siete pacientes fueron operados por vía laparoscópica. La mediana de ganglios extirpados fue de 21.54 ± 7.32. Se revelaron ganglios linfáticos positivos en el 24.3% de los casos. Se diagnosticó fuga anastomótica en un paciente. Conclusiones. El análisis preoperatorio cuidadoso de la anatomía vascular en la angiografía 3D-TC evaluará la vascularización del ángulo esplénico del colon, reducirá el tiempo intraoperatorio para identificar estructuras y desarrollará una estrategia personalizada para la cirugía.

RESUMO RACIONAL: A angiografia 3D-TC permitiu alcançar um nível qualitativamente novo na determinação de táticas de tratamento para pacientes com câncer colorretal. OBJETIVO: Analisar os aspectos clínicos e radiológicos que precisam ser discutidos antes da cirurgia por uma equipe multidisciplinar em pacientes com câncer de cólon direito. MÉTODOS: Analisar 103 pacientes com câncer colorretal submetidos à angiotomografia 3D pré-operatória entre 2016 e 2021. RESULTADOS: Todos os pacientes foram submetidos à hemicolectomia direita radical D3. A quantidade mediana de linfonodos removidos foi de 24,71±10,04. Deiscência de anastomose foi diagnosticada em 1 paciente. Identificamos 8 tipos mais comuns de artéria mesentérica superior. Em 64 pacientes (62,1%) a artéria ileocólica cruzou a veia mesentérica superior na face anterior e em 39 (37,9%), na face posterior. Em 58 pacientes (56,3%) a artéria cólica direita estava ausente ou era um ramo não independente da artéria mesentérica superior. A distância da raiz da artéria mesentérica superior à raiz da artéria cólica média foi de 37,8±12,8 mm e a distância da raiz da artéria cólica média até a raiz da artéria ileocólica foi de 29,5±15,7 mm. Em 66 pacientes (64,1%) o tronco de Henle estava acima da raiz da artéria cólica média, em 16 (15,5%) o tronco de Henle estava no mesmo nível da artéria cólica média e em 18 pacientes (17,5%) o tronco de Henle estava abaixo da artéria cólica média. CONCLUSÕES: A angiografia 3D-CT pré-operatória é um padrão chave na avaliação da anatomia vascular e pode potencialmente mostrar a complexidade de uma futura linfadenectomia e reduzir o risco de deiscência da anastomose.

ABSTRACT BACKGROUND: 3D-CT angiography has made it possible to reach a qualitatively new level in the determination of treatment tactics for patients with colorectal cancer. AIMS: This study aimed to analyze the clinical and radiological aspects that need to be discussed before surgery by a multidisciplinary team in patients with right-sided colon cancer. METHODS This study involved 103 patients with colorectal cancer who underwent preoperative 3D-CT angiography from 2016 to 2021 RESULTS: All patients underwent radical D3 right hemicolectomy. The median quantity of removal lymph nodes were 24.71±10.04. Anastomotic leakage was diagnosed in one patient. We have identified eight most common types of superior mesenteric artery. The ileocolic artery crossed the superior mesenteric vein on the anterior surface in 64 (62.1%) patients and on the posterior surface in 39 (37.9%). In 58 (56.3%) patients, the right colic artery was either absent or was a nonindependent branch of superior mesenteric artery. The distance from the root of the superior mesenteric artery to the root of the middle colic artery was 37.8±12.8 mm and that from the root of the middle colic artery to the root of the ileocolic artery was 29.5±15.7 mm. The trunk of Henle was above the root of the middle colic artery in 66 (64.1%) patients, at the same level with the middle colic artery in 16 (15.5%), and below the middle colic artery in 18 (17.5%) patients. CONCLUSIONS: Preoperative analysis of 3D-CT angiography is a key pattern in assessment of vascular anatomy and can potentially show the complexity of future lymphadenectomy and reduce the risk of anastomotic leakage.