Minimally invasive surgery for right-sided colon cancer with superior mesenteric artery rotation: clinical features and short-term outcomes.

[PURPOSE] To evaluate the clinical characteristics and short-term outcomes of minimally invasive surgery (MIS) for right-sided colon cancer with superior mesenteric artery rotation (SMAR) when the SMA is found, intraoperatively, to run anterior to the superior mesenteric vein (SMV) in the ileocolic root area.

[METHODS] The subjects of this retrospective analysis were patients with right-sided colon cancer, who underwent MIS with D3 lymph node dissection between 2018 and 2024. We compared the clinical characteristics and short-term outcomes of MIS in patients with and those without SMAR. The findings of SMAR were defined on preoperative computed tomography as ct-SMAR.

[RESULTS] Among the 523 patients included in this analysis, there were 513 (98.1%) without SMAR and 10 (1.9%) with SMAR. It was identified that 60.0% of the patients with SMAR had cecum cancer vs.25.1% of those without SMAR. The sensitivity and specificity of the findings of ct-SMAR were 80.0% and 97.5%, respectively. Both operative time (183 min vs. 231 min, p = 0.004) and blood loss (0 mL vs. 27 mL, p = 0.012) were significantly higher in the patients with SMAR.

[CONCLUSION] The vascular course in patients with SMAR differs from the usual pattern and this may increase the risk of unexpected vascular injury, potentially leading to intraoperative bleeding and prolonged operative time.