Right colic artery anatomy: a systematic review of cadaveric studies

Abstract

Background: Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular tie and adherence to embryonic planes during dissection, supported by preoperative scanning to accurately define the tumour lymphovascular supply and drainage. The authors support and recommend precision oncosurgery based on these principles, with an emphasis on the importance of understanding the vascular anatomy. However, the anatomical variability of the right colic artery (RCA) has resulted in significant discord in the literature regarding its precise arrangement.

Methods: We systematically reviewed the literature on the incidence of the different origins of the RCA in cadaveric studies. An electronic search was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations up to October 2016 using the MESH terms 'right colic artery' and 'anatomy' (PROSPERO registration number CRD42016041578).

Results: Ten studies involving 1073 cadavers were identified as suitable for analysis from 211 articles retrieved. The weighted mean incidence with which the right colic artery arose from other parent vessels was calculated at 36.8% for the superior mesenteric artery, 31.9% for the ileocolic artery, 27.7% for the root of the middle colic artery and 2.5% for the right branch of the middle colic artery. In 1.1% of individuals the RCA shared a trunk with the middle colic and ileocolic arteries. The weighted mean incidence of 2 RCAs was 7.0%, and in 8.9% of cadavers the RCA was absent.

Conclusions: This anatomical information will add to the technical nuances of precision oncosurgery in right-sided colon resections.

Keywords: Complete mesocolic excision; Oncosurgery; Right colic artery.

Fig. 1

Right colic feeding vessel systematic review: preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram

Fig. 2

Right colic artery (RCA) arising from the right branch of the middle colic artery (RBMC). MCA middle colic artery; SMA superior mesenteric artery; ILC ileocolic artery (permission for reproduction granted by the Annals of the Royal College of Surgeons of England)

Fig. 3

Right colic artery (RCA) arising from the root of the middle colic artery (MCA), i.e. before it bifurcates to give a left and right branch. SMA superior mesenteric artery (permission for reproduction granted by the Annals of the Royal College of Surgeons of England)