Optimization of Artery-First Approach in Right-Sided Colon Cancer CME: Preoperative CTA Assessment of MCA Branching and MCV–Henle’s Trunk Relationship

Backgroud: Vascular injury, particularly involving Henle’s trunk, remains a major challenge during complete mesocolic excision (CME) for right-sided colon cancer. Due to the high anatomical variability of right-sided colonic vessels, the influence of tumor location, and heterogeneity in operative techniques, radical right hemicolectomy (RRC) continues to be a high-risk procedure. This study aims to identify strategies that reduce vascular injury and enhance mesenteric margin integrity in standardized CME surgery. Material and methods: Patients with right-sided colon cancer underwent manual subtraction CTA to determine MCA branching types and MCV–Henle’s trunk configurations. Based on these findings, individualized surgical plans were established emphasizing artery-first, sheath-based dissection. Operative outcomes were compared with those of conventional CME cases regarding intraoperative bleeding, vascular injury rate, and the subjective assessment of mesenteric margin integrity. Results: Preoperative CTA successfully identified MCA and MCV–Henle’s trunk types in >90% of patients. The CTA-guided artery-first group showed significantly fewer venous injuries and improved exposure of the Henle’s trunk and SMV compared with the conventional group. No MCV injuries occurred, and CME specimen integrity improved steadily with experience. Conclusions: Manual subtraction CTA allows accurate visualization of fine vascular anatomy and facilitates a safe, artery-first CME strategy for right-sided colon cancer. CTA-guided sheath dissection reduces intraoperative venous bleeding and improves surgical precision.