Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery

Seike, Kazuhiro; Koda, Keiji; Saitô, Norio; Oda, Kazuhiro; Kosugi, Chihiro; Shimizu, Kimio; Miyazaki, Masaru

doi:10.1007/s00384-006-0221-7

Cited by 159 publications

(152 citation statements)

References 25 publications

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“…Several studies11, 12, 13 have shown that colonic blood flow is decreased in high‐tie compared with low‐tie ligation. Two reports28 29 have described the development of proximal bowel necrosis or ischaemia after high‐tie ligation (2 and 0·8 per cent respectively).…”

Section: Discussionmentioning

confidence: 99%

“…High‐tie ligation has been advocated1, 2, 3, 4, 5, 6 because it allows more radical resection and more accurate pathological staging. Others7, 8, 9, 10, 11, 12, 13 favour low‐tie ligation because of increased blood flow to the proximal end of the anastomosis. This debate goes all the way back to the descriptions by Miles14 and Moynihan15 in 1908.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Though there is still no consistent evidences of the survival benefits (Hida and Okuno, 2013), it is proved that high ligation of the IMA may improve lymph node removal rates (Adachi et al, 1998), accuracy of tumor staging (Titu et al, 2008). Though high ligation of the IMA causes a reduction of blood supply to distal colon (Seike et al, 2007;Tsujinaka et al, 2012), it simultaneously contributes to low anastomosis with no tension in low anterior resection of rectal cancer Hida and Okuno, 2013). In fact, the rate of ischemic necrosis of anastomosis is very low in clinical observations (Tsujinaka et al, 2012;Park et al, 2012) and no statistically significant difference between the high and low ligation of the IMA is found…”

Section: Introductionmentioning

confidence: 99%

New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer

Yang

Li²,

Luo³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…High ligation of IMA pedicle enables anastomotic perfusion only through the marginal artery, whereas a low ligation enables anastomotic perfusion not only through the marginal artery but also through the left colic artery and its ascending branch. On the basis of this hypothesis, low ligation of the IMA pedicle should result in lower anastomotic leakage rates [25,26]. However in this study, none of the patients with the high ligation were found to develop anastomotic leakage whereas 10.5 % patients with low ligation developed anastomotic leakage, though the difference did not reach statistical significance (p = 0.13).…”

Section: Discussionmentioning

confidence: 52%

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Jatal

Pai

Demenezes

et al. 2015

Indian J Surg Oncol

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The primary objective of this study was to determine whether sphincter preservation is possible among patients who develop anastomotic leakage after rectal cancer surgery. The secondary objective was to determine the factors that may contribute to anastomotic leakage. This is a retrospective review of a prospectively maintained database. All patients with rectal cancer who underwent restorative proctectomy over 1 year were included in the study. The parameters analyzed were age, preoperative hemoglobin and albumin, neoadjuvant therapy, type of surgery, level of ligation of inferior mesenteric pedicle, technique of anastomosis, and defunctioning proximal stoma. In this study, 176 cases of anterior resection were included,of which15 (8.5 %) had anastomotic leakage. None of the factors contributing to anastomotic leakage reached statistical significance on univariate analysis. Among the patients who had proximal defunctioning ileostomy (n = 9), five (56 %) required re-surgery whereas other four were managed with antibiotics and presacral drainage alone (44 %). Among the patients who didnot have proximal defunctioning ileostomy (n = 6), all (100 %) required re-surgery. Among the 12 eligible patients, stoma reversal was successful in eight (67 %) patients. This study highlights the importance of defunctioning proximal stoma in reducing the incidence and severity of anastomotic leakage as well as the need and extent of re-surgery for low rectal cancer. Sphincter preservation is possible in majority of patients who develop anastomotic leakage after rectal cancer surgery.

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Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery

Cited by 159 publications

References 25 publications

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

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

New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

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