Mesenteric vascular variations and Henle's trunk anatomy in right colon cancer surgery: implications for complete...

Complete mesocolic excision (CME) with central lymphadenectomy represents the oncologic standard for right colon cancer surgery. However, vascular anatomical variability particularly involving the superior mesenteric vessels and Henle's gastrocolic trunk may substantially increase operative complexity and hemorrhagic risk. This study aimed to evaluate mesenteric vascular variations systematically and to analyze their implications for the quality and safety of CME/D2 right hemicolectomy.

A retrospective descriptive single-center study was conducted at a tertiary referral university hospital. A total of 250 consecutive patients who underwent oncologic right hemicolectomy for histologically confirmed adenocarcinoma of the right colon between January 2020 and January 2025 were included. Clinical, radiological, operative, pathological, and postoperative data were analyzed. Mesenteric vascular anatomy was evaluated using CT angiography (available in 51.2% of cases) and correlated with intraoperative observations. The study was reported according to the STROBE criteria.

The mean patient age was 64.5 ± 11.2 years (range 28-89) with slight female predominance (55.2%). Complicated presentations (obstruction, perforation, hemorrhage) occurred in 31.2% of cases. CT angiography was available for 128/250 patients (51.2%); its incomplete use was primarily attributable to emergency/complicated presentations (41.0% of the 122 non-angiography cases), resource/protocol constraints (34.4%), and adequate standard CT for planning (24.6%). The ileocolic and middle colic arteries were invariably present. The right colic artery was absent in 35.2% of patients, with variable origins when present. Henle's trunk was identified in 59.2% of patients, with three distinct venous configurations characterized. Open surgery was performed in 67.2% of cases. No major intraoperative vascular injury was recorded. Adequate lymph node harvest (≥12 nodes) was achieved in all patients (mean 24.6 ± 6.8 nodes). Anastomotic leakage occurred in 2.4% and 30-day mortality in 0.8%.

Mesenteric vascular variations are the rule rather than the exception during right colon cancer surgery. Preoperative CT angiography with vascular reconstruction appears to facilitate operative planning and anatomical orientation during CME/D2 lymphadenectomy. Standardized vascular-oriented dissection may improve oncologic quality while minimizing vascular complications.