Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial

Zirui He; Chunkang Yang; Dechang Diao; Deqing Wu; Abe Fingerhut; Yueming Sun; Yuan Gao; Nan Wang; Ang Li; Weidong Tong; Peirong Ding; Yi Xiao; Xiaojun Zhou; Zhangfa Song; Su Yan; Hongwei Yao; Wenjian Meng; Kejian Huang; Donglei Zhou; Anlong Zhu; Hao Wang; Yiming Zhou; Xinxiang Li; Liang Kang; Xuan Zhao; Hao Su; Minhua Zheng; Kai Ye; Quan Wang; Yincong Guo; Yun Lu; Bo Feng

doi:10.1016/j.ijsu.2022.106718

Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial

Int J Surg. 2022 Aug:104:106718. doi: 10.1016/j.ijsu.2022.106718. Epub 2022 Jun 17.

Authors

Zirui He¹, Chunkang Yang², Dechang Diao³, Deqing Wu⁴, Abe Fingerhut⁵, Yueming Sun⁶, Yuan Gao⁷, Nan Wang⁸, Ang Li⁹, Weidong Tong¹⁰, Peirong Ding¹¹, Yi Xiao¹², Xiaojun Zhou¹³, Zhangfa Song¹⁴, Su Yan¹⁵, Hongwei Yao¹⁶, Wenjian Meng¹⁷, Kejian Huang¹⁸, Donglei Zhou¹⁹, Anlong Zhu²⁰, Hao Wang²¹, Yiming Zhou²², Xinxiang Li²³, Liang Kang²⁴, Xuan Zhao¹, Hao Su¹, Minhua Zheng¹, Kai Ye²⁵, Quan Wang²⁶, Yincong Guo²⁷, Yun Lu²⁸, Bo Feng²⁹

Affiliations

¹ Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.
³ Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China.
⁴ Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁵ Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
⁶ Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, China.
⁷ Genneral Surgical Clinic, Affiliated Hospital of Qingdao University, Qingdao, China.
⁸ Tangdu Hospital, Air Force Medical University, Xi'an, China.
⁹ Xuanwu Hospital Capital Medical University, Beijing, China.
¹⁰ Daping Hospital,Army Medical University, Chongqing, China.
¹¹ Sun Yat-Sen University Cancer Center, Guangzhou, China.
¹² Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
¹³ The First Affiliated Hospital of Soochow University, Suzhou, China.
¹⁴ Department of Colorectal Surgery, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China.
¹⁵ Qinghai University Affiliated Hospital, Qinghai, China.
¹⁶ Beijing Friendship Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Gastrointestinal Surgery, West China Hospital, Chengdu, China.
¹⁸ Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹⁹ ShangHai Tenth People's Hospital of Tongji University, Shanghai, China.
²⁰ First Affiliated Hospital of Harbin Medical University, Harbin, China.
²¹ Changhai Hospital, Navy Military Medical University, Shanghai, China.
²² Huashan Hospital, Fudan University Shanghai Medical College, Shanghai, China.
²³ Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
²⁴ Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²⁵ Second Affiliated Hospital of Fujian Medical University, Fuzhou, China. Electronic address: [email protected].
²⁶ The First Hospital of Jilin University, Changchun, China. Electronic address: [email protected].
²⁷ Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China. Electronic address: [email protected].
²⁸ Genneral Surgical Clinic, Affiliated Hospital of Qingdao University, Qingdao, China. Electronic address: [email protected].
²⁹ Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: [email protected].

PMID: 35724803
DOI: 10.1016/j.ijsu.2022.106718

Abstract

Background: Recent interest in laparoscopic right colectomy with D3 lymphadenectomy for right colon cancer, has raised renewed attention to the anatomic variations of the gastrocolic trunk of Henlé (GTH). Understanding the vascular structure of the GTH region for individual patients should improve surgical outcomes. The goal of this nationwide multicenter study (Anatomical Classification of Henlé's Trunk in Laparoscopic Right Hemi-colectomy (HeLaRC) trial) was to study the anatomic patterns of the GTH region, to clarify the implications of GTH in laparoscopic right colectomy with D3 lymphadenectomy (D3-RC) and analyze their clinical significance.

Methods: We enrolled 583 patients from 26 centers across China who underwent D3-RC. The number of tributaries, length and types of GTH constitutions and their influence on intra-operative data were investigated. A nomogram score (based on the length of GTH, body mass index (BMI), tumor location, T stage and type of GTH (type I vs. non-type I) was established to assess the potential hazard of bleeding.

Results: The GTH was found in 567 patients (97.3%). The distribution of GTH types was 0 (14.1%, n = 80), I (53.3%, n = 302), II (27.0%, n = 153), III (5.6%, n = 32). Of note, the type I GTH, T1 stage and tumor location at ileocecal or ascending colon were correlated with shorter exposure time of the GTH region (P < 0.0001). Short length of GTH (P = 0.002) and tumor location (transverse colon vs. non transverse colon) (P = 0.003) were correlated with the amount of GTH bleeding during the surgery. Nomogram discrimination was good (C-index: 0.72 (95% CI: 0.64, 0.80)). The dissection plane was better in patients with type I GTH than with other types (P = 0.023).

Conclusion: GTH pattern variations may affect surgical outcomes in patients undergoing D3-RC. Better recognition of GTH anatomy might lead to a safer operation with better oncologic quality.

Keywords: Gastrocolic trunk of henlé; Laparoscopic D3 right colectomy.

Publication types

Multicenter Study

MeSH terms

Colectomy
Colon, Transverse*
Colonic Neoplasms*
Humans
Laparoscopy*
Lymph Node Excision