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Laparoscopic Hemicolectomy for Left Colon Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Ashwin deSouza, Shankar Malpangudi
The left colic artery is the first lateral branch of the inferior mesenteric artery, which divides into an ascending branch that courses towards the splenic flexure and a descending branch, which goes towards the sigmoid colon. Latarjet described two variations for the origin of the left colic artery [7]. These are important to note as they become relevant in the nodal dissection at the root of the IMA. Type 1, or a spread-out origin is one where the left colic artery has a separate origin several centimeters away from the origin of the IMA. The sigmoid vessels originate from the IMA a further few centimeters distal to the left colic artery origin. Type 2, or fan-shaped origin is one where the left colic and sigmoid branches share a common origin from the IMA, arising in a fan-shaped manner (Figure 21.2).
Mesenteric and renal angiography
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The SMA usually originates 1 cm lower than the celiac trunk and anterior to the L1 vertebral body.[1] The SMA travels inferiorly and slightly rightward to supply the duodenum and pancreas. In its course, the SMA passes beneath the pancreas and divides into the inferior pancreaticoduodenal, middle colic, right colic, ileocolic, and intestinal branches (Figure 24.2). In general, the middle colic artery provides blood supply to the proximal and midtransverse colon. In some individuals, the middle colic may provide the main source of blood to the splenic flexure. The right colic artery provides the blood supply to the middle and distal ascending colon, while the ileocolic artery supplies the distal ileum, cecum, and proximal ascending colon. The middle, right, and ileocecal branches join together with the left colic artery (from the inferior mesenteric) forming the marginal artery or artery of Drummond that courses along the inside border of the colon. Multiple anatomic variations of the colic arteries exist.
Splenic flexure and left hemicolectomy
Published in Mark Coleman, Tom Cecil, Brian Dunkin, Laparoscopic Colorectal Surgery, 2017
Kathryn Thomas, Charles Maxwell-Armstrong, Austin Acheson
The debate was succinctly summarised by Kennedy et al. (6), discussing oncological and operative outcomes as well as technical issues. Oncological outcome is generally accepted to not be compromised when the left colic artery is preserved (i.e. splenic flexure is not mobilised). Leak rate related to this is more contentious, but studies comparing the two techniques (7,8), although small, do not appear to show a significant difference. Overall, outside of diverticular disease surgery, a selective approach would appear the most reasonable, with employment of other techniques for obtaining adequate length where necessary.
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
In cases of splenic flexure tumors, extended left colon resection was undertaken. The distal 2/3 of the transverse colon and left colon was performed in accordance with CME and CVL. During CME and CVL, ligation was performed at the point where the left colic artery branches off the inferior mesenteric artery along the aortic border and at the exit point of the left middle colic artery. The left-GEOM region covering the gastrocolic ligaman and omentum was dissected along a vertical line drawn from the transverse colon into the stomach from at least 10 cm proximal of the tumor and included in the specimen together with the infrapancreatic lymph nodes and the distal part of the anterior pancreas peritoneum. The right branch of the middle colic artery was preserved. Anastomosis was undertaken between the transverse and sigmoid colon.
Difference between right-sided and left-sided colorectal cancers: from embryology to molecular subtype
Published in Expert Review of Anticancer Therapy, 2018
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The endodermal gut tube created by body folding during the fourth week of gestation consists of a blind-ended cranial foregut, a blind-ended caudal hindgut, and a midgut open to the yolk sac through the vitelline duct [11]. The midgut forms the distal duodenum, jejunum, ileum, cecum, ascending colon, and proximal two-thirds of the transverse colon. The hindgut forms the distal third of the transverse colon, the descending and sigmoid colon, and the upper two-thirds of the anorectal canal. Just superior to the cloacal membrane, the primitive gut tube forms an expansion called the cloaca. During the fourth to sixth weeks, a coronal urorectal septum partitions the cloaca into the urogenital sinus, which will give rise to urogenital structures, and a dorsal anorectal canal [12]. As the right and left sides of the colon derive from different embryologic origins, anatomically, the proximal colon receives its main blood supply from the superior mesenteric artery with its capillary network being multilayered. The distal colon is perfused by the inferior mesentery artery. Between these two main sources, there is a watershed area located just proximal to the splenic flexure where branches of the left branch of the middle colic artery anastomose with those of the left colic artery. This area represents the border of the embryologic midgut and hindgut. Venous drainage of the colon largely follows the arterial supply with superior and inferior mesenteric veins draining both the right and left halves of the colon.