Angiographic protocol for preoperative planning of minimally invasive colorectal surgery
Ts. Ivanov, N. Stanislavova, D. Angelov, D. Dimitrov
Minimally invasive surgery (MIS) is now a standard method of surgical treatment for colorectal cancer (CRC), and the proof of the clear benefits come from large multicentric randomized trials. MIS is technically challenging compared to the conventional open surgery and this is why accurate preoperative planning is necessary. A prospective study was conducted for the period from January 2017 to September 2018, covering 20 cases of CRC patients in which minimal invasive radical surgery was performed. In all cases, the surgical tactic is planned preoperatively by mesenteric computer tomographic angiography. Preoperatively the individual anatomy of the superior mesenteric artery and vein as well as the inferior mesenteric artery and vein are studied. Ileocolic artery was found in all 20 cases, and in 55% of the cases it was in ventral direction of superior mesenteric vein. Opposite, the right colic artery is found in three of the researched patients. According to the anatomical models of the inferior mesenteric artery found in our research, the latter is grouped into three groups, from which the most common variant found in the study is type C, in which the left colic artery and sigmoid arteries are independent of each other branches, found in 10 the patients of the research. Computer tomographic mesenteric angiography is a non-invasive, fast and accurate method for preoperative assessment of individual vascular anatomy of the colon and the rectum that can be used for preoperative planning of MIS in treatment of CRC patients. Additional studies on theclinical benefits of this technique are needed.
Key words: COLORECTAL CANCER. MINIMALLY INVASIVE SURGERY. COMPUTED TOMOGRAPHY. MESENTERIC ANGIOGRAPHY