Clinical impact of inferior mesenteric vein preservation during left hemicolectomy with low ligation of the inferior mesenteric artery for distal transverse and descending colon cancers: A comparative study based on computed tomography

Abstract

PurposePresence of a long remnant sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation for distal transverse and descending colon cancers may be a risk factor for venous ischemia. This study aimed to evaluate the clinical impact of IMV preservation in patients who underwent left hemicolectomy with inferior mesenteric artery (IMA) preservation.MethodsWe included 155 patients who underwent left hemicolectomy with IMA preservation for distal transverse and descending colon cancers from 2003 to 2020. Technical success of IMV preservation was determined by assessing pre- and post-operative patency of the IMV on computed tomography (CT) by an abdominal radiologist. Intestinal complications comprising ulceration, stricture, venous engorgement, and colitis in remnant colon were compared between the IMV preservation and ligation groups.ResultsIMV was preserved in 22 (14.2%) and ligated in 133 (85.8%) patients. Surgical time, postoperative recovery outcomes, and number of harvested lymph nodes were similar in both groups. The technical success of IMV preservation was 81.8%. Intestinal complications were less common in the preservation group than in the IMV ligation group (4.5% vs. 23.3%, P=0.048). The complications in the IMV ligation group were anastomotic ulcer (n=2), anastomotic stricture (n=4), venous engorgement of the remnant distal colon (n=4), and colitis in the distal colon (n=21).ConclusionsIMV preservation may be beneficial after left hemicolectomy with IMA preservation for distal transverse and descending colon cancers. We suggest that IMV preservation might be considered when long remnant sigmoid colon is expected during left hemicolectomy with low ligation of IMA.

Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report

“…Fuji et al [ 2 ] reported that congestive ischemic colitis occurred in 4 (2.1%) of the 191 patients following left-sided colectomy where the arterial branch (superior rectal artery) was preserved, and the IMV was cut near the root. Similarly, Suh et al [ 5 ] reported an incidence of 2.25% (3/133 patients). Congestive ischemic colitis is believed to be caused by venous congestion resulting from an imbalance between the arterial supply and venous return of the remnant colon after colectomy for left colon cancer[ 2 , 5 ].…”

“…Similarly, Suh et al [ 5 ] reported an incidence of 2.25% (3/133 patients). Congestive ischemic colitis is believed to be caused by venous congestion resulting from an imbalance between the arterial supply and venous return of the remnant colon after colectomy for left colon cancer[ 2 , 5 ]. The descending and sigmoid colons receive blood from the left colic, sigmoid, and superior rectal arteries, originating from the IMA.…”

“…Congestion is more likely to occur when the remnant distal colon is lengthy. Therefore, in that case, preserving the IMV during surgery might be considered to prevent venous congestion and subsequent congestive ischemic colitis[ 5 ].…”

“…Abdominal CT shows continuous bowel wall thickening below the anastomosis site, and the rectum is unaffected in most cases. CT angiography shows engorgement of the sigmoid vasa recta without any vascular abnormalities, including stenosis or obstruction[ 2 , 5 ]. Furthermore, colonoscopy reveals edema, erythema, and ulceration consistent with the findings of ischemic colitis[ 1 , 6 ].…”

The Atlas of the Inferior Mesenteric Artery and Vein under Maximum-Intensity Projection and Three-Dimensional Reconstruction View

“…Conversely, other research indicated that preserving the LCA provides better blood supply, reduces the likelihood of anastomotic leakage, and better preserves urinary and reproductive function [8][9][10]. Over the last few years, the anatomy of the inferior mesenteric vein (IMV) has also garnered increased attention, as selecting the appropriate ligation site of the IMV helps prevent postoperative congestion of the anastomosis [11][12][13]. Therefore, it is crucial to have a thorough understanding of the branching pattern of the IMV prior to surgery.…”