Blood Flow Path Reconstruction in Rectal Cancer

Blood Flow Path Reconstruction in Rectal Cancer After High IMA Ligation Through Preoperative and Postoperative Comparison by Manual Subtraction CTA

A total of 89 patients with distal sigmoid and rectal cancer were referred for observation and underwent MS-CTA between June 2020 and March 2022. The distribution of the left colic artery (LCA) was classified, and the presence of the accessory middle colic artery (AMCA) was assessed. Blood flow paths were planned preoperatively based on the classification of LCA branches. High ligation was performed during standard radical surgery. Intraoperatively, particular care was taken to preserve the bifurcation of the ascending and descending branches of the LCA. The planned blood flow paths were then compared with the actual postoperative blood flow paths to validate the previously proposed mechanism.

Inclusion Criteria:

• Clinical diagnosis of distal sigmoid colon or rectal cancer
• cTNM stage confirmed as I-III on MRI or CT
• Undergoing laparoscopic anterior resection (LAR)

Exclusion Criteria:

• Arterial phase scanning initiated too early
• Unclear anatomic structure on imaging
• No postoperative enhanced CT