BACKGROUND: Laparoscopic right hemicolectomy (LRH) with complete mesocolic excision with central vascular ligation (CME-CVL) is the preferred treatment for right colon cancer due to superior oncologic outcomes, higher lymph node yield and accurate staging.  However, it is associated with the risk of vascular injury and bleeding due to close dissection to superior mesenteric vessels.

CASE STUDY: A 60-year man with a 2-month history of colicky right lower abdominal pain had an ascending colon growth on colonoscopy with biopsy suggestive of adenocarcinoma. CECT Abdomen showed an ascending colon tumor of cT3N+M0 staging. Superior mesenteric vein (SMV) was formed just before the porto-splenic confluence by the union of a jejunal and an ileo-colic trunk, on either side of the superior mesenteric artery (SMA). He was planned for LRH with CME-CVL.  Four ports were placed and dissection started by incising the peritoneum along SMA. The jejunal and ileal trunks were identified and preserved. Ileocolic, right branch of middle colic vessels and Superior right colic vein were ligated sequentially followed by medial-to-lateral mobilisation of right colon. The specimen was retrieved via periumbilical incision and hand-sewn extracorporeal ileo-transverse anastomosis was done. His postoperative course was uneventful and he was discharged on day 5. Histopathology showed a moderately differentiated adenocarcinoma of pT3N1 with 1/17 lymph nodes positive. At a 3-month follow-up, he is doing well and receiving adjuvant chemotherapy.

CONCLUSION: Knowledge of anatomic variants of superior mesenteric vessels from the pre-operative CT scan helps in the safe conduct of LRH with CME-CVL procedure.