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Anania G, Campagnaro A, Chiozza M, Randolph J, Resta G, Marino S, Pedon S, Agrusa A, Cuccurullo D, Cirocchi R. A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on anatomical variants of the superior mesenteric artery: intraoperative analysis during laparoscopic right hemicolectomy-CoDIG 2 database (ColonDx Italian Group). Updates Surg 2024:10.1007/s13304-024-01787-6. [PMID: 38526696 DOI: 10.1007/s13304-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
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Affiliation(s)
- G Anania
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Campagnaro
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
| | - M Chiozza
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - G Resta
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Marino
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Pedon
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. Colli Monaldi Hospital, Napoli, NA, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, PG, Italy
- Division of Digestive and Emergency Surgery, Santa Maria Hospital, Via Tristano di Joannuccio 05100, Terni, TR, Italy
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Anania G, Chiozza M, Campagnaro A, Bagolini F, Resta G, Azzolina D, Silecchia G, Cirocchi R, Agrusa A, Cuccurullo D, Guerrieri M. Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?-CoDIG 2 (ColonDx Italian Group). Surg Endosc 2024; 38:1432-1441. [PMID: 38191814 PMCID: PMC10881627 DOI: 10.1007/s00464-023-10607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). METHODS CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. RESULTS A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). CONCLUSIONS This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.
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Affiliation(s)
- G Anania
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - M Chiozza
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy.
| | - A Campagnaro
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - F Bagolini
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - G Resta
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - D Azzolina
- Division of Scienze dell'Ambiente e della Prevenzione, University of Ferrara, Ferrara, FE, Italy
| | - G Silecchia
- Department of Scienze Medico Chirurgiche e Medicina Traslazionale, University of Roma S. Andrea University Hospital, Rome, RM, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, PG, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. dei Colli Monaldi Hospital, Naples, NA, Italy
| | - M Guerrieri
- Division of Clinica Chirurgica Generale e D'Urgenza, Università Politecnica delle Marche, Ancona, AN, Italy
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