ANALYSIS OF VASCULAR ANATOMY AND LYMPH-NODE METASTASES WARRANTS RADICAL SEGMENTAL BOWEL RESECTION FOR COLON-CANCER

To determine the indications for limited colon cancer surgery in each location, we reviewed the arterial branching patterns and lymph node m etastases along the course of specific vascular trunks in 344 colon ca ncer patients who had undergone preoperative angiography and colectomy with lymph node dissection, Our conclusions are follows: Because the ileocecal artery always arises from the superior mesenteric artery and lymph node metastases of cecum cancer were limited to nodes along the ileocolic artery, cecum cancer can be cured by ileocecal resection. T he right colic artery has various origins, and ascending colon cancer shows various patterns of lymph node metastases. Therefore a right hem icolectomy should be performed for ascending colon cancer. The middle colic artery forks into right and left branches, and each branch has d ifferent branching variations. If the right colic and middle colic art eries have a common trunk, a right hemicolectomy should be performed f or transverse colon cancer on the right side. If the left branch of th e middle colic artery has an independent replaced origin, lymph node d issection should be modified according to the variant origin, If the l eft colic artery and the first sigmoidal artery have a common trunk, t he lymph nodes along the common trunk should be removed for sigmoid co lon cancer and for descending colon cancer, Of the patients with sigmo id colon cancer, 6.3% also had lymph node metastases along the superio r rectal artery. Given that the lymph nodes along the superior rectal artery are skeletonized, sigmoid colon cancer can be also cured by par tial sigmoidectomy.