Personalized evaluation of D3-lymph node dissection complexity for right colorectal cancer considering anatomy of superior mesenteric vessels

Objective. To provide a personalized approach to D3 lymph node dissection (LND) in right colon cancer using a proper analysis and interpretation of CT angiography of superior mesenteric vessels. Material and methods. An observational cross-sectional study included 34 patients who underwent surgery for right colon cancer with D3 LND along superior mesenteric artery (SMA) and vein (SMV). Characteristics of surgically relevant vascular anatomy were evaluated as 0 or 1 depending on complexity of anatomical characteristic. Patients were classified into groups of standard (0 points) and complex (1—3 points) LND according to complexity of vascular anatomy. Results. SMA and SMV crossed each other at the level of ileocolic artery (ICA) orifice or above in 23.5% of cases (n=8). In 76.5% of cases, they passed parallel to each other (n=25). Ileocolic artery passed posteriorly to SMV in 47.1% (n=16) of cases. A closed type of SMA with a restricted access to D3 area was observed in 41.2% of cases (n=14). Duration of LND significantly differed (43.6±17.8 min in standard cases and 61.9±18.6 min in complex ones, p=0.006). Conclusion. Vascular anatomy can predict complexity of D3 LND in right colon cancer surgery. The complexity scale is an important tool for preoperative planning of D3 LND and identifying technical difficulties associated with vascular anatomy.