Terminal Reaches of the Branches from Middle Colic Artery and Their Correlation with Right Colic Artery

Terminal reaches of the branches from middle colic artery (MCA) vary a lot and were rarely reported. This leads to the anatomical ambiguity of whether middle colic artery right branch feeds the ascending colon and needs to be divided in cecal tumor surgery. Ultra-thin abdominal CT images (0.5-mm thickness) from January 2017 to December 2017 were prospectively collected and analyzed. Bifurcation pattern and terminal reaches of the middle colic artery branches and right colic artery and the distances from the root of ileocolic artery to middle colic artery were examined. A total of 231 patients were included in this study. Middle colic artery bifurcated into two branches in 74.0% of the cases. Middle colic artery right branch supplied the ascending colon in 13.4% and the proximal third of transverse colon in 53.7% of the cases. Right colic artery was found in 29.9%, and its presence was strongly associated with the feeding areas of middle colic artery branches. When right colic artery was present, middle colic artery right branch rarely reached the ascending colon (1.5% vs. 18.5%, p < 0.001), and fewer chance that middle colic artery left branch supplied the proximal third of transverse colon (17.0% vs. 44.4%, p = 0.004), and the distance from ileocolic artery root and middle colic artery root was longer (30.72 SD19.72 vs. 21.46 SD9.24 mm, p < 0.001). The terminal reaches of middle colic artery right branch at ascending or transverse colon were closely correlated with the presence of right colic artery. This could help provide anatomical basis for individualized vessel management for cecal cancer surgery and reduce the operational difficulty.