“High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial” (HIGHLOW trial)

Mari, Giulio; Maggioni, Dario; Costanzi, Andrea; Miranda, Angelo; Rigamonti, L; Crippa, Jacopo; Magistro, Carmelo; Lernia, Stefano Di; Forgione, Antonello; Carnevali, Pietro; Nichelatti, Michele; Carzaniga, Pierluigi; Valenti, Francesco; Rovagnati, Marco; Berselli, Mattia; Cocozza, Eugenio; Livraghi, Lorenzo; Origi, Matteo; Scandroglio, Ildo; Roscio, Francesco; Luca, Antonio De; Ferrari, Giovanni; Pugliese, Raffaele

doi:10.1186/s13063-014-0537-5

Cited by 21 publications

(9 citation statements)

References 27 publications

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“…It is important also to consider that some factors may affect the origin of the IMA, such as higher body weight, female gender and younger age [13]. Lastly, low and high ligation are both suggested to confer specific advantages, in terms of reduced genitourinary dysfunction or improved lymphadenectomy [18,43]. This is clearly beyond the scope of this review, but a clear understanding of the IMA and how it varies enables this decision to be made by the surgeon.…”

Section: Resultsmentioning

confidence: 99%

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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The objective of this review is to describe the normal and variant anatomy of the inferior mesenteric artery (IMA), including a brief overview of the relevant embryology, as well as proposing a classification system of the IMA vasculature, and clinical significance. A systematic review of articles published in Google Scholar and PubMed database using search terms: inferior mesenteric artery anatomy, inferior mesenteric artery variation, inferior mesenteric artery development, mesenteric circulation anatomy and variation, inferior mesenteric artery angiography. This was followed by review of the reference list of relevant publications to reveal publications missed during the initial search. Several standard anatomy and surgery text books were also referred for normal anatomy. The anatomy of the inferior mesenteric system is highly variant, with only a small proportion of anatomical, angiographic or surgical studies providing support for what is traditionally taught to be normal anatomy. Whilst the origin of the inferior mesenteric artery is less variant, the branching into left colic, sigmoidal and superior rectal arteries is variable between individuals in terms of origin of branches, number of branches and the presence or absence of certain branches. Whilst there did not appear to be a common classification system, similarities included three main variants of branching with a colosigmoid trunk, recto-sigmoid trunk or common trifurcation. There is a disparity between what is described in anatomical texts as the 'normal' IMA, and what is seen in anatomical, radiological and surgical research studies. The variable anatomy of the inferior mesenteric artery and its branches is significant in radiological interpretation and colorectal surgery from both an oncological perspective when considering resection, as well as in colonic ischaemia. A classification system has been introduced with a stepwise approach to the assessment of the IMA anatomy to avoid misleading nomenclature and provide a framework for surgeons to assess the vasculature.

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Section: Resultsmentioning

confidence: 99%

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

McSweeney¹,

Kotakadeniya

Dissabandara

2020

SN Compr. Clin. Med.

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“…Shiomi and co‐workers33 reported that the incidence of anastomotic leakage was lower for low than for high tie in a prospective multicentre cohort study. A randomized multicentre study34 is currently in progress. Finally, patients and treatment schedules may differ between Japan and countries in the West, where a significant proportion of patients would have had neodjuvant radiotherapy or chemoradiotherapy, unlike patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

et al. 2018

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BackgroundThe optimal level for inferior mesenteric artery ligation during anterior resection for rectal cancer is controversial. The aim of this randomized trial was to clarify whether the inferior mesenteric artery should be tied at the origin (high tie) or distal to the left colic artery (low tie).MethodsPatients were allocated randomly to undergo either high‐ or low‐tie ligation and were stratified by surgical approach (open or laparoscopic). The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were duration of surgery, blood loss and 5‐year overall survival.ResultsSome 331 patients entered the trial between June 2006 and September 2012. The trial was stopped prematurely as recruitment was slow. Seven patients were excluded after randomization but before operation because of procedural changes. High tie and low tie were performed in 164 and 160 patients respectively. The incidence of anastomotic leakage was not significantly different (17·7 versus 16·3 per cent respectively; P = 0·731). The incidence of severe complications requiring intervention was 2·4 versus 5·0 per cent for high and low tie respectively (P = 0·222). In multivariable analysis, risk factors for anastomotic leakage included male sex (odds ratio 4·36, 95 per cent c.i. 1·56 to 12·18) and distance of the tumour from the anal verge (odds ratio 0·99, 0·98 to 1·00). At 5 years there were no significant differences in overall (87·2 versus 89·4 per cent respectively; P = 0·386) and disease‐free (76·3 versus 77·6 per cent; P = 0·765) survival.ConclusionThe level of ligation of the inferior mesenteric artery does not significantly influence the rate of anastomotic leakage. Registration number: NCT01861678 ( https://clinicaltrials.gov).

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“…In laparoscopic radical resection for rectal cancer, according to the location of the tie of the IMA, it is divided into the high-tie of the IMA at its origin and the low-tie of the IMA below the branch into the LCA with preservation of the LCA. Currently, there is still controversy regarding the indications for high-tie or low-tie approaches[ 7 - 9 ]. In traditional rectal cancer surgery, a high tie of the IMA is preferred.…”

Section: Discussionmentioning

confidence: 99%

Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

Wang¹,

Cheng²,

Li³

et al. 2018

WJG

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AIMTo investigate the vascular anatomy of inferior mesenteric artery (IMA) in laparoscopic radical resection with the preservation of left colic artery (LCA) for rectal cancer.METHODSA total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery (SA) and superior rectal artery (SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein (IMV) and LCA was also evaluated.RESULTSThree vascular types were identified in this study. In type A, LCA arose independently from IMA (46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA (23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location (30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases.CONCLUSIONThe vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.

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“High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial” (HIGHLOW trial)

Cited by 21 publications

References 27 publications

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

A Comprehensive Review of the Anatomy of the Inferior Mesenteric Artery: Branching Patterns, Variant Anatomy and Clinical Significance

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

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