A systematic review and meta-analysis of variants of the branches of superior mesenteric artery: the Achilles heel of right hemicolectomy with complete mesocolic excision (CME)?

Abstract

BACKGROUND\nDissection with subsequent ligation and resection of arteries at their origin (central vascular ligation, CVL) is essential for adequate oncological resection during right hemicolectomy (RH) with complete mesocolic excision (CME). This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon METHODS: A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, SCOPUS, and Web of Science (WOS) to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software.\n\n\nRESULTS\nA total of 41 studies (n= 4,691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4-99.8), 72.6% (95% CI 61.3-82.5) and 96.9% (95% CI 94.2-98.8) of patients respectively. Supernumerary RCA and MCA were observed in 3.2% and 11.4% of all cases respectively. The RCA shared a common trunk with ICA and MCA in 13.2% and 17.7% of patients respectively. A retro-superior mesenteric vein (SMV) course of the ICA and RCA was observed in 55.1% and 11.4% of all cases respectively.\n\n\nCONCLUSION\nThe vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-SMV courses. These variations should be taken into consideration during RH with CME to ensure adequate oncological resection while minimizing intraoperative complications.