Rare anatomical variants of the inferior mesenteric artery basin at the Preoperative and intraoperative stages in patients undergoing d3 lymph Dissection with preservation of the left colic artery

Abstract

The aim of the work: to analyze rare variants of IMA basin anatomy and study the nuances that may complicate and increase the time of D3 lymph node dissection with preservation of LCA.

Materials and Methods. The study included 103 patients (56 men and 47 women; mean age (64.2±11.6)) with cancer of the left half of the colon and rectum who underwent preoperative 3D-CT angiography in Ternopil University Hospital between 2016 and 2021 years. In this study, we set the following objectives: to determine the type of IMA, the distance from the root of the IMA to the aortic bifurcation, the distance from the IMA to the LCA, the distance from the LCA to the junction with the IMV.

Results and Discussion. All our patients underwent D3 lymph node dissection with LCA preservation. Anastomotic leakage did not occur in any patient. The average number of removed lymph nodes was (21.4±7.1) (12–45). The frequency of metastatic lesions of the apical group of lymph nodes was 7.5 %. One of the rarest variants of Zebrowski IMA branching is types C, D and G. In our study, we found that the distance of LCA from the IMA was (35.29±10.18) mm (11–66 mm). Particular attention should be paid to clinical cases with a distance of LCA from the IMA more than 5 cm, which also contributes to the increased operation time required for skeletonization of the above vessels and compliance with all oncological canons of D3 lymph node dissection. We found rare cases of high IMA discharge at the level of the renal arteries. Another reference point to pay attention to is the intersection of LCA with IMV, which according to our analysis is (20.97±13.59) mm (range 2–65).