The recent interest in laparoscopic right colectomy with D3 lymphadenectomy for right colon cancer has rekindled interest in the anatomic variants of the gastrocolic trunk of Henlé (GTH). Understanding the vascular anatomy of the GTH area might enhance surgical results in individual patients. For a nationwide multicenter study (Anatomical Classification of Henlé’s Trunk in Laparoscopic Right Hemi-colectomy (HeLaRC) trial), researchers sought to investigate the anatomic patterns of the GTH region, as well as to clarify the implications of GTH in laparoscopic right colectomy with D3 lymphadenectomy (D3-RC) and analyze their clinical significance.
They included 583 D3-RC patients from 26 different hospitals. The number of tributaries, length, type of GTH constitutions, and their impact on intra-operative data was studied. A nomogram score (based on GTH length, BMI, tumor location, T stage, and type of GTH (type I vs. non-type I) was developed to measure the possible risk of bleeding.
GTH was discovered in 567 patients (97.3%). GTH types were distributed as follows: 0 (14.1%, n=80), I (53.3%, n=302), II (27.0%, n=153), and III (5.6%, n=32). Notably, shorter GTH exposure duration was associated with type I GTH, T1 stage, and tumor site at ileocecal or ascending colon (P<0.0001). The quantity of GTH bleeding during surgery was linked with GTH length (P=0.002) and tumor location (transverse colon vs. non-transverse colon) (P=0.003). The discrimination of nomograms was good (C-index: 0.72 (95% CI: 0.64, 0.80)). Patients with type I GTH had a better dissection plane than those with other kinds (P=0.023).
Variations in GTH patterns may impact surgical results in D3-RC patients. A greater understanding of GTH anatomy might lead to a safer procedure with higher oncologic quality.