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Gastrocolic Trunk of Henle and Its Variants: Review of the Literature and Clinical Relevance in Colectomy for Right‑Sided Colon Cancer

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Gastrocolic Trunk of Henle and Its Variants: Review of the Literature and Clinical Relevance in Colectomy for Right‑Sided Colon Cancer Surgical and Radiologic Anatomy (2019) 41:879–887 https://doi.org/10.1007/s00276-019-02253-4 REVIEW Gastrocolic trunk of Henle and its variants: review of the literature and clinical relevance in colectomy for right‑sided colon cancer Roberto Peltrini1 · Gaetano Luglio1 · Gianluca Pagano1 · Michele Sacco1 · Viviana Sollazzo1 · Luigi Bucci1 Received: 11 March 2019 / Accepted: 4 May 2019 / Published online: 14 May 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Purpose Venous vascular anatomy of the right colon presents a high degree of variability. Henle’s Gastrocolic Trunk is considered an important anatomical landmark by colorectal surgeons. The classical description concerns a bipod vascular structure or tripod, but several variants are associated to it. The aim of this study is to merge the most updated literature on the anatomy knowledge of the Gastrocolic Trunk by evaluating all possible variants, as well as to underline its surgical importance due to its topographical relationships. Methods Twelve studies describing the anatomy of the gastrocolic trunk were selected, each of them dealing with a more or less extensive series of cases. A distinction was drawn between the gastropancreatic trunk, devoid of the colonic component, and the gastrocolic trunk; and then the frequency of the diferent resulting variants was reported. The data obtained from cadavers and radiological studies were analyzed separately. Results The Gastrocolic Trunk is found in 74% of cadaver studies, and in 86% of radiological studies. Its most frequent confguration is represented by the union of right gastroepiploic vein + anterior superior pancreaticoduodenal vein + superior right colic vein, respectively, 32.5% and 42.5%, followed by the right colic vein which replaces (26.9%, 12.3%) or is added (10%, 20.1%) to the superior right colic vein. Conclusions The superior right colic vein joins the right gastroepiploic vein and the anterior superior pancreaticoduodenal vein thus forming, in most cases, the gastrocolic trunk. The anatomical knowledge of vascular structures forms the basis for both the interpretation of preoperative radiological images and the surgical procedure itself, despite the considerable anatomical variability of tributaries. Keywords Gastrocolic trunk · Henle · Right colic veins · Right colectomy · Colon cancer Introduction Since the vascular anatomy, especially the venous anatomy * Roberto Peltrini of the right colon, varies, scientifc literature continues to [email protected] arouse interest in this topic by ofering several articles on Gaetano Luglio this subject [1, 2, 17, 21–24, 28, 31, 35, 44, 45]. [email protected] When facing the region at the lower border of the pan- Gianluca Pagano creas head and neck, surgeons have to take the following into [email protected] consideration: the fusion of the greater omentum with the Michele Sacco transverse mesocolon and the wide anatomical variability of [email protected] the tributary veins of the superior mesenteric vein (SMV). Viviana Sollazzo In pancreatic and colorectal surgery, these veins can be [email protected] identifed and carefully dissected to avoid bleeding because Luigi Bucci of iatrogenic injuries, such as excessive traction on the [email protected] mesocolon or during SMV dissection. Furthermore, such vascular structures might be already involved in pathologi- 1 Department of Clinical Medicine and Surgery, University cal processes such as pancreatic head tumors [21, 23, 28]. of Naples Federico II, Via Pansini 5, 80131 Naples, Italy Vol.:(0123456789)1 3 880 Surgical and Radiologic Anatomy (2019) 41:879–887 In colorectal surgery, the introduction of complete meso- were selected. The evaluation methods are summarized in colic excision (CME) for surgical treatment of colon cancer, three categories: cadaveric anatomy (Cadav.), radiological by preserving the mesocolic plane and high tie of the supply- anatomy by Computed Tomography (CT), intraoperative ing arteries, led to signifcantly improved patient outcomes anatomy (lntraop.) Because of the great variability in the in Erlangen, where the 5-year cancer-related survival is now terminology adopted by the various authors, it is necessary at 89% and the local recurrence rate is less than 4% after to clarify some defnitions: the Ileocolic Vein (ICV) was R0 resections [16, 41–43]. To perform right hemicolectomy defned as the tributary from the ileocecal marginal veins to with CME, the following actions are necessary: adequate the SMV; the Right Colic Vein (RCV) and the Middle Colic mobilization of the right colon, complete lymph node dis- Vein (MCV) were defned, respectively, as the veins that section along the surgical trunk, and complete resection of drained from the marginal veins of the ascending colon and the mesocolon. the transverse colon to the SMV. When two or three MCVs The misrecognition of the vessels could lead to trouble- were present, the biggest was known as the main MCV while some bleeding whose control can be difcult without suf- the smallest MCVs were defned as accessory ones (aMCV) fcient anatomical knowledge. Previous studies showed that [44]. The Superior Right Colic Vein (SRCV) was defned bleeding occurred during ligation of the vascular pedicle as the tributary from the marginal veins of the right fexure in 3–9.2% of laparoscopic right colectomy cases, requiring of the colon to the confuence of the GCT or the SMV [21]. conversion to open surgery in 1–2% of cases [26, 39]. The GCT for Henle was frst described in 1868 as the confu- Hohenberger et al. focused on this critical region (“bleed- ence of the SRCV and the right gastroepiploic vein (RGEV) ing point”) in the surgical community and standardized draining into the Superior Mesenteric Vein [14]. dissection of these veins as guiding structures that lead to As a third element, in 1912 Descomps and De Lalaubie the SMV in right-sided CME [16]. In this region, the Gas- [6] added the anterior Inferior Pancreaticoduodenal Vein trocolic Trunk of Henle (GCT) is considered an important (AIPDV) to this confuence, so that the trunk became a anatomical landmark by many surgeons [17, 30] especially tripod. The diference in nomenclature for a contributing for hepatic fexure and transverse colon cancers. According pancreaticoduodenal vein, as reported by Descomps, De to the Japanese Society for Cancer of the Colon and Rectum Lalaubie in 1912 and Gillot et al. in 1962 [11] (AIPDV), in (JSCCR), GCT defnes, together with middle colic artery, contrast to the Anterior Superior Pancreaticoduodenal Vein the cranial border of the D3 area [37] and because of the (ASPDV) as reported in the majority of more recent reports remarkable anatomical variability of the veins fowing into [1, 21, 22, 24, 28, 29] is not completely clear. it, it holds a key position in the dissection of the infrapan- The results that follow will show how the original bipod creatic lymph node region (ILR) for hepatic fexure and of confguration described by Henle is found less frequently the transverse colon cancers. than the other combinations; among these we deliberately This study aims to provide an anatomical basis for Hen- separated the one without a colonic component defning it as le’s GCT, in particular for its colonic component, still uncer- Gastropancreatic Trunk (GPT), according to a recent study tain for its complexity and variability, based on a review of [22]. the available scientifc literature and on data analysis ofered Therefore, the frequency of these vascular structures by the various authors’ case series. It is believed that the (GPT and GCT) and the diferent combinations of right and knowledge of these venous structures and their anatomical transverse colon veins which participated in the formation relationships can ofer a valid support during surgery to pre- of the GCT itself, when this is present, were reported. The vent vascular and organ injuries, to maintain the surgical analysis of the data was then performed separately according planes and obtain an optimal lymph node dissection. to the evaluation methods: cadaver or CT, considering these ones to be the most accurate, thus excluding intraoperative and mixed evaluations [23]. Materials and methods A literature search in PubMed was performed to identify Results studies evaluating GCT anatomy using the following search terms: ʻgastrocolic trunkʼ, ʻHenle trunkʼ, ʻright colon venous Twelve studies, dealing with a variable number of cases, anatomyʼ, ʻright colic veinsʼ. Search results were supple- have described the anatomical confguration of the GCT mented by manual search of selected references to identify in detail using radiological and anatomical examination on additional studies missing in the initial search. To be eligible cadavers or intra-operative methods. For each study the gas- a study had to provide a case series of anatomical description tropancreatic conformation (GPT) has been reported, and reporting on the tributaries of the GCT; only full texts and specifcally the gastro-pancreato-colic (GCT) with its vari- English-language studies were considered. Twelve studies ants (Table 1). 1 3 Surgical and Radiologic Anatomy (2019)41:879–887 and Radiologic Anatomy Surgical Table 1 Case series of anatomical GCT description Authors Zhang et al. Lange et al. Yamaguchi et al. Jin et al. Ignjatovic et al. Sakaguchi et al. Ogino et al. Açar Miyazawa Lee et al. Alsabilah et al. Kuzu et al. [22] [45] [23] [44] [21] [17] [35]b [31]b et al. [1] et al. [28] [24] [2]c Year 1994
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