远端乙状结肠癌手术治疗的方法之一是节段性结肠切除术并保留左结肠动脉（LCA）的血管。 D3 淋巴结清扫术在技术上可能会根据不同的血管解剖结构而有所不同。本研究旨在根据肠系膜下动脉 (IMA) 分支的不同模式，展示远端乙状结肠癌保留 LCA 的 D3 淋巴结清扫方法。常规进行 3D 重建 CT 血管造影来识别 IMA 分支模式。所有病例均采用标准化方式进行腹腔镜远端乙状结肠切除术、D3 淋巴结清扫术和左结肠动脉保留术。包括临床、术中和短期手术结果在内的数据以中位数 (Me) 和四分位距 (IQR) 形式呈现。26 名远端乙状结肠癌患者接受了腹腔镜远端乙状结肠切除术。 D3淋巴结清扫的方法根据不同的解剖变异而不同。高 BMI 患者中发生 1 例中转（3.8%）和 1 例吻合口漏（3.8%）。同时，由于 IMA 的骨架化，顶端淋巴结计数较高（Me 3 (IQR 2-5)，最小-最大 0-10）。左结肠动脉 D3 淋巴结清扫的技术问题无论标准化的解剖标志如何，不同类型的 LCA 和乙状动脉分支模式的保存可能会有所不同。进行保留血管的淋巴结清扫术时应考虑解剖学特征。© 2024。Springer Nature Switzerland AG。

One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching.CT angiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR).Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA.The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.© 2024. Springer Nature Switzerland AG.