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Banipal GS, Stimec BV, Andersen SN, Faerden AE, Edwin B, Baral J, Benth JŠ, Ignjatovic D. Interactions of occult tumor spread and surgical technique on overall and disease-free survival in patients operated for stage I and II right-sided colon cancer. J Cancer Res Clin Oncol 2021; 147:3535-3543. [PMID: 34427788 PMCID: PMC8557178 DOI: 10.1007/s00432-021-03773-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
Purpose To determine if “medial to lateral” (ML) dissection with devascularization first is superior to “lateral to medial” (LM) dissection regarding numbers of lymph node micro metastases (MM) and isolated tumor cells (ITC) as well as 5-year disease-free (5YDFS) and 5-year overall survival (5YOS) in stage I/II right-sided colon cancer. Methods Two datasets are used. ML group consists of consecutive stage I/II patients from a prospective trial. LM group is the original dataset from a previous publication. All harvested lymph nodes are examined with monoclonal antibody CAM 5.2 (immunohistochemically). Lymph node harvest and 5YOS/5YDFS were compared between ML/LM groups, stage I/II tumors and MM/ITC presence/absence. Results 117 patients included ML:51, LM:66. MM/ITC positive in ML 37.3% (19/51), LM 31.8% (21/66) p = 0.54. The 5YDFS for patients in ML 70.6% and LM 69.7%, p = 0.99, 5YOS: 74.5% ML and 71.2% LM (p = 0.73). No difference in 5YDFS/5YOS between groups for Stage I/II tumors; however, LM group had an excess of early tumors (16) when compared to ML group, while lymph node harvest was significantly higher in ML group (p < 0.01) 15.1 vs 26.7. 5YDFS and 5YOS stratified by MM/ITC presence/absence was 67.5%/71.4%, p = 0.63, and 75.0%/71.4%, p = 0.72, respectively. Death due to recurrence in MM/ITC positive was significantly higher than MM/ITC negative (p = 0.012). Conclusion Surgical technique does not influence numbers of MM/ITC or 5YDFS/5YOS. Presence of MM/ITC does not affect 5YOS/5YDFS but can be a potential prognostic factor for death due to recurrence. Clinical trial Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography” registered at http://clinicaltrials.gov/ct2/show/NCT01351714 .
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Affiliation(s)
- G S Banipal
- Department of Digestive Surgery, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - B V Stimec
- Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - S N Andersen
- Department of Pathology, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A E Faerden
- Department of Digestive Surgery, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway
| | - B Edwin
- Interventional Centre and Department of HPB Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Baral
- Department of Colorectal Surgery, Klinikum Karlsruhe, Karlsruhe, Germany
| | - J Šaltytė Benth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway
| | - D Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stimec BV, Ignjatovic D. Navigating the mesentery: Part III. Unusual anatomy of ileocolic vessels. Colorectal Dis 2020; 22:1949-1957. [PMID: 32734680 DOI: 10.1111/codi.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/18/2020] [Indexed: 02/08/2023]
Abstract
AIM The ileocolic vessels are important landmarks in advanced surgery of the midgut. The aim of the present study is to present variations of ileocolic vessels relevant to complete mesocolic excision with D3 lymphadenectomy of the right colon, within their detailed and precise morphometric framework and deriving from a large and consistent series of operated patients. METHODS An ongoing prospective trial 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multidetector Computed Tomography Angiography' was reviewed. The imaging datasets underwent manual segmentation and 3D reconstruction, and the results were validated at surgery. A total of 356 patients were included in the study. RESULTS A cross-section of the series revealed five cases (1.4%) with variation of ileocolic vessels relevant to complete mesocolic excision or D3 extended mesenterectomy. There were two cases with absence of a true classical ileocolic artery, two cases with absence of a true classical ileocolic vein, and one case of precocious bifurcation of the ileocolic artery, left to the superior mesenteric vein. The entire D3 area in all the cases was thoroughly documented and analysed from the morphometric point of view (calibres, lengths of vessels, crossing patterns). CONCLUSION The preoperative visualization of a patient's individual 3D anatomy is a powerful tool in identifying the variations whose negligence could have dire consequences in complete mesocolic excision of the right colon.
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Affiliation(s)
- B V Stimec
- Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - D Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Nesgaard JM, Stimec BV, Bakka AO, Edwin B, Ignjatovic D. Navigating the mesentery: part II. Vascular abnormalities and a review of the literature. Colorectal Dis 2017; 19:656-666. [PMID: 28008705 DOI: 10.1111/codi.13592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/17/2016] [Indexed: 02/08/2023]
Abstract
AIM Vascular abnormalities present advantages and/or disadvantages for the patient undergoing surgery. The aims of this study were to define, classify and demonstrate the courses, and to assess the clinical value, of arterial and venous abnormalities in the central mesentery. METHOD We conducted a review of the anatomy of 340 patients planned for enrolment in the 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography' trial, 312 of whom were submitted to surgery. Vascular abnormalities were analysed in context with surgical notes and images. A meta-analysis of the literature was performed. RESULTS Arterial Abnormalities were found in 28 (8.2%) of the 340 patients and were classified into the following three groups based on anticipated surgical difficulty: group 1, accessory or replaced arteries to solid organs [14 (4.1%)]; group 2, arterial shunts [11 (3.2%)] between the coeliac trunk and the superior mesenteric artery, which resulted in bleeding in three patients; and group 3, common stem abnormalities [3 (0.9%)]. Two groups of superior mesenteric vein abnormalities were noted. The first included morphological abnormalities in a single vein [4 (1.2%)]: aneurysm [1 (0.3%)]; and ring variants of principal tributaries [3 (0.9%)]. The second included double superior mesenteric vein trunks [31 (9.1%)]: genuine bifid [10 (2.9%)]; and pseudo bifid [21 (6.2%)]. The meta-analysis revealed 26 articles, including 10 series of anatomical dissections or angiographies [1970 cases with 205 (10.4%) arterial abnormalities] and 16 case reports, none of which described a clinical or surgical setting. CONCLUSION Vascular abnormalities occur frequently. Arterial abnormalities are a hazard when inadvertent injury occurs during surgery. Preoperative knowledge of a bifid superior mesenteric vein is useful.
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Affiliation(s)
- J M Nesgaard
- Department of Gastrointestinal Surgery, Vestfold Hospital, Tonsberg, Norway
| | - B V Stimec
- Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
| | - A O Bakka
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Edwin
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Interventional Centre, Gastrointestinal and Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - D Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Thorsen Y, Stimec B, Andersen SN, Lindstrom JC, Pfeffer F, Oresland T, Ignjatovic D. Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy. Tech Coloproctol 2016; 20:445-53. [PMID: 27137207 DOI: 10.1007/s10151-016-1466-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography" in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed. METHODS Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews. RESULTS Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores. CONCLUSIONS Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.
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Affiliation(s)
- Y Thorsen
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Stimec
- Anatomy Sector, Department of Cellular Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - S N Andersen
- Department of Pathology, Akershus University Hospital, University of Oslo, Lorenskog, Norway
| | - J C Lindstrom
- Helse Sør-Øst Health Services Research Center, Akershus University Hospital, Lorenskog, Norway
| | - F Pfeffer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - T Oresland
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - D Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.
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Nesgaard JM, Stimec BV, Bakka AO, Edwin B, Ignjatovic D. Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis 2015; 17:810-8. [PMID: 25988347 DOI: 10.1111/codi.13003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/26/2015] [Indexed: 02/08/2023]
Abstract
AIM Awareness of anatomy is critical for performing safe surgery within the root of the mesentery. Our aim was to investigate the anatomical relationship between the superior mesenteric artery (SMA) and vein (SMV) and their branches within a predefined D3 area of the right colon and to compare preoperatively established three-dimensional (3D) mesenteric vessel anatomy from CT with that found at surgery. METHOD Prospective data were collected on 139 patients included in the 'Safe Radical D3 Right Hemicolectomy for Cancer Through Preoperative Biphasic Multi-detector Computed Tomography (MDCT) Angiography' trial. CT data sets were 3D reconstructed before surgery and compared with photographs taken during the operation. RESULTS The ileocolic artery was present and correctly identified in all patients and crossed the SMV anteriorly in 58 (41.7%). Seventeen patients had a right colic artery at surgery and there were three false-negative and one false-positive CT findings, yielding a diagnostic accuracy of 97.1%, sensitivity of 85.7% and specificity of 95.2%. Positive and negative predictive values were 94.7% and 97.5%, respectively. The middle colic artery was absent in one (0.7%) patient and multiple (nine double and one triple) in 10 (7.2%) patients. A mean of 3.8 ± 1.2 jejunal arteries and 2.0 ± 0.8 jejunal veins arose from the SMA and SMV. Jejunal veins crossed the SMA in the D3 area anteriorly in 30.9% of patients. In 26 (18.7%) patients, additional veins drained into the SMV, including pancreaticoduodenal in 16, right colic in six and both in two. The inferior mesenteric vein entered the SMV in 58 (41.7%) patients and crossed the D3 area in three (2.2%). CONCLUSION CT-reconstructed anatomy has high specificity, sensitivity, accuracy and reliability.
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Affiliation(s)
- J M Nesgaard
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway
| | - B V Stimec
- Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland
| | - A O Bakka
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Edwin
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Interventional Centre, Gastrointestinal and Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - D Ignjatovic
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway
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Sukalovic V, Bogdan AE, Tovilovic G, Ignjatovic D, Andric D, Kostic-Rajacic S, Soskic V. N-{[2-(4-Phenyl-piperazin-1-yl)-ethyl]-phenyl}-arylamides with Dopamine D2and 5-Hydroxytryptamine 5HT1AActivity: Synthesis, Testing, and Molecular Modeling. Arch Pharm (Weinheim) 2013; 346:708-17. [DOI: 10.1002/ardp.201300189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/22/2013] [Accepted: 07/26/2013] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Gordana Tovilovic
- Department of Biochemistry; Institute for Biological Research; University of Belgrade; Belgrade Serbia
| | - Djurdjica Ignjatovic
- Department of Biochemistry; Institute for Biological Research; University of Belgrade; Belgrade Serbia
| | - Deana Andric
- Faculty of Chemistry; University of Belgrade; Belgrade Serbia
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Kiil S, Stimec BV, Spasojevic M, Fasel JHD, Ignjatovic D. 3D for D3: role of imaging for right colectomy in a case with congenital superior mesenteric vein aneurysm and co-existing anomalous irrigation. Chirurgia (Bucur) 2013; 108:256-258. [PMID: 23618578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The D3 right colectomy for cancer requires dissection in the vicinity of the superior mesenteric vessels, which requires preoperative 3D imaging in these patients. CASE REPORT We present a patient with a caecum adenocarcinoma cancer which underwent D3 resection of the right colon, preceded by pre-operative MDCT with 2D multiplanar reconstruction and 3D volume rendering. RESULTS The dataset analysis revealed a rare congenital aneurysm of the superior mesenteric vein below the spleno-mesenteric confluence and a co-existing anomalous irrigation in the form of an ileo-mesenteric trunk. The surgical procedure was carried out as planned and the patient presents no signs of recurrence of the disease one year after the intervention. CONCLUSIONS The case presented - with a rare and complicated vascular situs - illustrates particularly well that multimodal post-processing of the CT dataset for volume rendering allows proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and accomplishing the delicate operation, avoiding the surgical pitfalls and iatrogenic injuries.
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Affiliation(s)
- S Kiil
- Department of Vascular Surgery, Vestfold Hospital, Tonsberg, Norway
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Shafique M, Ignjatovic D. Splenic lobe/segment dearterialization. Tech Coloproctol 2012; 16:471; author reply 475. [PMID: 22936581 DOI: 10.1007/s10151-012-0868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/24/2012] [Indexed: 11/28/2022]
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Sukalovic V, Ignjatovic D, Tovilovic G, Andric D, Shakib K, Kostic-Rajacic S, Soskic V. Interactions of N-{[2-(4-phenyl-piperazin-1-yl)-ethyl]-phenyl}-2-aryl-2-yl-acetamides and 1-{[2-(4-phenyl-piperazin-1-yl)-ethyl]-phenyl}-3-aryl-2-yl-ureas with dopamine D2 and 5-hydroxytryptamine 5HT(1A) receptors. Bioorg Med Chem Lett 2012; 22:3967-72. [PMID: 22607670 DOI: 10.1016/j.bmcl.2012.04.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 04/15/2012] [Accepted: 04/20/2012] [Indexed: 11/18/2022]
Abstract
It is suggested that the ratio of dopamine D(2) to 5-hydroxytryptamine 5-HT(1A) activity is an important parameter that determines the efficiency of antipsychotic drugs. Here we present the synthesis of N-{[2-(4-phenyl-piperazin-1-yl)-ethyl]-phenyl}-2-aryl-2-yl-acetamides and 1-{[2-(4-phenyl-piperazin-1-yl)-ethyl]-phenyl}-3-aryl-2-yl-ureas and their structure-activity relationship studies on dopamine D(2) and 5-hydrohytryptamine 5-HT(1A) receptors. It was shown that ligand selectivity and affinity strongly depends on their topology and the presence of a pyridyl group in the head of molecules. Molecular modeling studies using homology modeling and docking simulation revealed a rational explanation for the ligand behavior. The observed binding modes and receptor-ligand interactions provided us with a clue for optimizing the optimal selectivity towards 5-HT(1A) receptors.
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Affiliation(s)
- Vladimir Sukalovic
- ICTM-Department of Chemistry, University of Belgrade, Njegoseva 12, 11000 Belgrade, Serbia
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Spasojevic M, Stimec BV, Fasel JF, Terraz S, Ignjatovic D. 3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography. Surg Endosc 2010; 25:1883-6. [PMID: 21136104 DOI: 10.1007/s00464-010-1480-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 10/19/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND 3-D relations between the ileocolic (ICA), right colic artery (RCA) with the superior mesenteric vein (SMV) have been described in cadavers. However, no data exists on preoperative evaluation of these relations. AIM To define the length of crossing and 3-D position of the ICA and RCA to the SMV in patients undergoing multidetector computerized tomography (MDCT) angiography. METHODS MDCT angiographies were analyzed with the aid of Osirix v.3.0.2. image processing application. All the datasets included arterial and venous phase, undergoing multimodal visualization: 2D multiplanar reconstruction with maximum intensity projection and 3D Volume rendering. The anatomical relations were analyzed in various planes (orthogonal and oblique), depending upon their particular course. When a clear spatial reference was achieved, the distance of the colic artery from their origin on the aorta to the right border of the SMV was measured, and its position noted. RESULTS 50 MDCT were analyzed (29 male). RCA occurred in 27 patients (54.0%), 25 (92.6%) passed anterior to the SMV. Length of crossing was 22.7±8.1 (8.3-41.3) mm. The ICA occurred in 48 (96%) passing under the SMV in 38 (79.2%). Length of crossing 15.4±5.8 (14.0-26.6) mm. CONCLUSIONS RCA occurs in 54% patients, passes over the SMV in 92.6% specimens and leaves a 22.7 mm stump. ICA passes under the SMV in most cases, leaving a 15.4 mm stump. These data could be of crucial importance to the surgeon facing laparoscopic right colectomy for cancer.
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Affiliation(s)
- M Spasojevic
- Department of Gastrointestinal surgery, Vestfold Hospital, P.O. Box 2168, 3103, Tonsberg, Norway
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Ignjatovic D, Sund S, Stimec B, Bergamaschi R. Vascular relationships in right colectomy for cancer: clinical implications. Tech Coloproctol 2007; 11:247-50. [PMID: 17676266 DOI: 10.1007/s10151-007-0359-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 03/19/2007] [Indexed: 12/30/2022]
Abstract
AIMS The study aim was to provide data on pattern and length of crossing of the ileocolic artery (ICA) and right colic artery (RCA) with the superior mesenteric vein (SMV). METHODS Specimens from 30 fresh human cadavers underwent corrosion casting. Methylacrylate was injected into the SMV and superior mesenteric artery (SMA). Length of crossing was measured with a scaleable ruler and copper wire. Values are mean (SD; range). RESULTS ICA was present in all specimens and crossed posterior to the SMV in 19 (63.33%) of 30 specimens. Length of crossing was 17.01 (7.84; 7.09-42.89) mm. RCA was present in 19 (63.33%) of 30 specimens. RCA crossed anterior to SMV in 16 (84.21%) of 19 specimens. Length of crossing was 20.63 (8.09; 6.3-35.7) mm. CONCLUSIONS ICA was always present, crossed posterior to SMV in 60% of specimens with a crossing length of 17 mm. RCA was present in 63% of specimens, crossed anterior to the SMV in 84% of specimens with a crossing length of 20 mm. Clinical implications include arterial length left behind with main nodes, arterial bleeding and safety of laparoscopic access.
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Affiliation(s)
- D Ignjatovic
- Department of Research and Development, Forde Health System, Forde, Norway
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Ignjatovic D, Bergamaschi R. New procedure for purse-string suture in thoracoscopic esophagectomy with intrathoracic anastomosis. Surg Endosc 2006; 21:1288. [PMID: 17165118 DOI: 10.1007/s00464-006-9078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 05/31/2006] [Indexed: 11/24/2022]
Affiliation(s)
- D Ignjatovic
- Department of Research and Development, Forde Health System, Bergen University, Forde, Norway, 6807
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Ignjatovic D, Ignjatovic M, Nutt DJ. Pharmacological Treatment of Late-Life Depression. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-862659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ignjatovic D, Stimec B, Zivanovic V. The basis for splenic segmental dearterialization: a post-mortem study. Surg Radiol Anat 2004; 27:15-8. [PMID: 15517263 DOI: 10.1007/s00276-004-0279-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Accepted: 05/29/2004] [Indexed: 11/29/2022]
Abstract
The anatomical features of splenic segmental vessels in 102 human spleen autopsy specimens were analyzed. Methods applied were corrosion casting and post-mortem arteriography. The superior terminal splenic branch divided extracapsularly into 2.8+/-0.9 (range 2-5) and the inferior terminal splenic branch into 2.3+/-0.75 (range 2-5) branches per sample. The extracapsular lengths of the segmental branches ranged from 4.0 to 16.7 mm and the calibers from 0.4 to 2.2 mm. Superior polar arteries occurred in 31.3% and inferior polar arteries in 20.6% of cases. Their average extracapsular lengths were 39 mm and 31 mm, respectively. In conclusion, segmental splenic arteries have an extrasplenic origin and course, with an average length and caliber that allow surgical access and ligation, in order to achieve segmental dearterialization for hemostasis purposes and splenic preservation.
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Affiliation(s)
- D Ignjatovic
- Surgical Clinic, KBC Dr Dragisa Misovic University Hospital, N.H.M. Tepica 1, 11000, Belgrade, Serbia & Montenegro.
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Ignjatovic D, Stimec B, Finjord T, Bergamaschi R. Venous anatomy of the right colon: three-dimensional topographic mapping of the gastrocolic trunk of Henle. Tech Coloproctol 2004; 8:19-21; discussion 21-2. [PMID: 15057584 DOI: 10.1007/s10151-004-0045-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The gastrocolic trunk of Henle has not been described in detail in context with right hemicolectomy. The aim of this study was to define the caliber, length and three-dimensional position of the gastrocolic trunk of Henle (GTH). METHODS We studied 10 fresh (<24 h) cadavers. A corrosion cast method was employed. Cold polymerized methylacrylate was injected into the superior mesenteric vein (SMV) and artery. GTH diameter, length and point of confluence with the SMV were assessed. RESULTS The GTH was present in all specimens originating from the confluence of the right gastroepiploic and superior-anterior pancreaticoduodenal veins. The GTH joined the SMV at an average distance of 2.2 cm (range, 1.6-3.2 cm) from the inferior pancreatic border and it coursed towards the right side in a ventral-cranial direction. The mean caliber and length of the GTH were 5.2 mm (range, 4.8-5.8 mm) and 16.1 mm (range, 10.1-20.7 mm), respectively. CONCLUSIONS The GTH is a short, medium-sized vessel of potential clinical significance with a consistent ventral-cranial direction.
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Affiliation(s)
- D Ignjatovic
- Department of Research and Development, Forde Health System, School of Medicine, Bergen University, 6807, Forde, Norway
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Abstract
Four factors influence the outcome of rectal surgery: tumour biology, stage of lesion, type of surgery performed and the performing surgeon himself. Tumour biology and tumour stage depend on each other and are not influenced on by the surgeon, while he seems to have a great influence on the latter two factors. This influence mainly consists of the following: training, volume, individual skill and experience.
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Affiliation(s)
- D Ignjatovic
- Department of Research and Development, Forde Health System, School of Medicine, Bergen University, Forde, Norway
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Ignjatovic D, Bergamaschi R. What role, if any, for laparoscopic surgery in Crohn's disease of the hindgut? Acta Chir Iugosl 2003; 49:9-12. [PMID: 12587460 DOI: 10.2298/aci0202009i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An outsider to the field of surgery would probably take it for granted that surgeons have a highly developed rationale for choosing a laparoscopic approach to Crohns disease. After all, an increasing number of surgeons are performing laparoscopic surgery for Crohns disease as witnessed by several articles published in the 1990s (Table). In fact this is not quite true. Most papers are case reports or series without controls, capable only of suggesting feasibility. Furthermore, comparison studies often feature selection flaws, and therefore beg the question of whether laparoscopic surgery should or not be considered as standard care. An attempt is made herein to give readers a concise insight of the evidence available in the English language literature. It does not pretend to offer a comprehensive review of the topic rather, it highlights some relevant issues, and then outlines what role, if any, laparoscopic surgery should play in Crohn's disease. There are at least 6 categories for discussion.
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Affiliation(s)
- D Ignjatovic
- University of Dergen, Forde Health System, Forde, Norway
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18
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Ignjatovic D, Bergamaschi R. Anatomical rationale for spleen salvage by lobe/segment dearterialization in inferior pole spleen injury during left hemicolectomy: a post-mortem study. Tech Coloproctol 2002; 6:93-5; discussion 95-6. [PMID: 12402053 DOI: 10.1007/s101510200020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to determine the rationale for spleen salvage by lobe/segment dearterialization without resection for inferior pole injury during left hemicolectomy. One hundred and two consecutive human cadavers were dissected. Corrosion case and post-mortem arteriography with computerized planimetry were employed. Lobe/segment size, artery diameter and length and anastomoses between arteries were measured. The mean inferior terminal splenic artery had a significantly smaller diameter than the superior (2.8 vs. 3.4 mm, p<0.01). An inferior polar artery was found in 22.5% of the specimens (mean diameter, 1.9 mm; mean length, 33 mm). The inferior lobe and inferior polar segment comprised 41.3% and 12.6% of the spleen, respectively. Anastomoses were detected in 34 of 102 spleens (3% extraparenchymal, 88% intraparenchymal, 9% combined). The mean diameter and length of intrasplenic anastomoses were 0.3 mm and 20 mm, respectively. In conclusion, there was a positive correlation between diameters of lobar/segmental arteries and vascular zones ( p<0.05). The rationale for splenic lobe/segment dearterialization without resection is found in the presence of intrasplenic anastomoses.
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Affiliation(s)
- D Ignjatovic
- Bergen University School of Medicine, 6800 Førde, Norway
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19
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Ignjatovic D, Ignjatovic M. Alzheimer's disease diagnostics and the treatment at the psychiatric out-patients department. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Ignjatovic M, Ignjatovic D. Differential diagnostics of panic disorder and following treatment of the psychiatric policlinic. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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22
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Ignjatovic D, Ignjatovic M, Durcik V. Magnetic resonance imaging as precipitating factor for the development of panic attack and possibility of pre-medication with paroxetin. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ignjatovic D, Bergamaschi R. Preserving the superior rectal artery in laparoscopic [correction of laparoscopis] anterior resection for complete rectal prolapse. Acta Chir Iugosl 2002; 49:25-6. [PMID: 12587465 DOI: 10.2298/aci0202025i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall challenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery.
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Affiliation(s)
- D Ignjatovic
- Bergen University School of Medicine, Forde Health System, Central Teaching Hospital, Forde, Norway
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Ignjatovic D, Djuric B, Zivanovic V. Is splenic lobe/segment dearterialization feasible for inferior pole trauma during left hemicolectomy? Tech Coloproctol 2001; 5:23-5. [PMID: 11793256 DOI: 10.1007/s101510100004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2000] [Accepted: 12/09/2000] [Indexed: 10/27/2022]
Abstract
We discuss splenic salvage by lobe/segment dearterialization, without resection, after intraoperative trauma, and present two cases. We performed a retrospective analysis of 163 patients in whom the colon splenic flexure was mobilized. Patients with ileo-rectal anastomosis or urgent cases were excluded. Surgical operations included left hemicolectomy and anterior resection of the rectum. Splenic procedures were splenorrhaphy, dearterialization and splenectomy. Spleen lesions occurred in 4 (2.45%) cases. One capsular tear was managed with splenorrhaphy. Three mechanical lesions to capsula and tissue of the inferior pole were managed by either splenectomy (the first case) or dearterialization. Overall mortality in the series was 4.3%. Among the patients with splenic procedures, the splenectomized patient died due to pulmonary embolism. The two cases treated by inferior splenic branch and inferior polar artery ligature are presented. In operative trauma to the inferior splenic pole, bleeding can be controlled by lobe/segment dearterialization and by methods of local hemostasis in most cases.
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Affiliation(s)
- D Ignjatovic
- KBC Dr Dragisa Misovic University Hospital, H. Milana Tepica 1, 11000 Belgrade, Yugoslavia
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Abstract
BACKGROUND Large laparoscopic cholecystectomy series often fail to report the rate at which a third structure is encountered in Calot's triangle. METHODS During a 6-month period, the liver and hepatoduodenal ligament of 90 consecutive human cadavers underwent corrosion casting (n = 50), postmortem arteriography (n = 20), and postmortem cholangiography (n = 20). RESULTS Third structures within Calot's triangle were arteries (0.6-5.7 mm diameter) in 36.2% (early division of the right hepatic artery, 8.6%; caterpillar hump right hepatic artery, 12.9%; liver branch of the cystic artery, 10%; double cystic arteries, 5.7%), bile ducts (0.3-1.6 mm diameter) in 5. 7% (small-caliber sectoral ducts, 1.4%; right posterior hepatic ducts, 4.3%), and veins (0.9-1.6 mm diameter) merging with the portal vein in 4% of the specimens. CONCLUSION Knowledge of the aforementioned anatomy is critical to surgeons facing more than two structures within Calot's triangle during laparoscopic cholecystectomy.
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Affiliation(s)
- R Bergamaschi
- Department of Surgery, University of Bergen, SSSF Hospital, Forde, Norway
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Bergamaschi R, Ignjatovic D. Anatomic rationale for arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy: a postmortem study. Surg Laparosc Endosc Percutan Tech 1999; 9:267-70. [PMID: 10871174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of this study was to establish an anatomic rationale for liver bed arterial bleeding during laparoscopic cholecystectomy. Fifty consecutive human cadavers were dissected. A corrosion cast method was used. Six anastomotic branches (12%) of the cystic artery to the right or left hepatic artery ran underneath the gallbladder serosa surface and entered liver parenchyma after crossing the medial or lateral edge of the liver fossa without passing through the areolar tissue of the liver bed. Their mean length was 18.3 mm (range 4-60), and the mean diameter was 0.38 mm (range 0.2-0.8). Two cystic arteries that ascended in the midline between the gallbladder and liver bed were identified in 50 (4%) casts. Their lengths were 16 and 18 mm, and their diameters were 1.9 and 2.2 mm. Five and seven branches encircling the gallbladder arose radially. These two arterial branching patterns can cause arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy.
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Affiliation(s)
- R Bergamaschi
- Institute of Surgery, University of Bergen, SSSF Hospital, Forde, Norway
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Abstract
OBJECTIVE To evaluate the effect of blast in common war injuries. METHODS One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not. RESULTS Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury. CONCLUSION In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.
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Affiliation(s)
- I Cernak
- Military Medical Academy, Belgrade, Yugoslavia.
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