Level of arterial ligation in sigmoid colon and rectal cancer surgery

Abstract

BackgroundCurative resection of sigmoid colon and rectal cancer includes “high tie” of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate, and it is unclear whether this confers a survival advantage. Accordingly, the IMA may be ligated at a point just below the origin of the left colic artery (LCA) “low tie” combined with lymph node dissection (LND) around the origin of the IMA (low tie with LND). However, no study has investigated the detailed prognostic results between “high tie” and “low tie with LND.” The aim of this study was to assess the utility of “low tie with LND” on survival in patients with sigmoid colon or rectal cancer.MethodsA total of 189 sigmoid colon or rectal cancer patients who underwent curative operation from 1997 to 2007 were enrolled in this study. The patient’s medical records were reviewed to obtain clinicopathological information. Overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method, with differences assessed using log-rank test.ResultsForty-two and 147 patients were ligated at the origin of the IMA (high tie) and just below the origin of the LCA combined with LND around the origin of the IMA (low tie with LND), respectively. No significant differences were observed in the complication rate and OS and RFS rates in the two groups. Further, no significant difference was observed in the OS and RFS rates in the lymph node-positive cases in the two groups.Conclusions“Low tie with LND” is anatomically less invasive and is not inferior to “high tie” with prognostic point of view.

Prognostic value of inferior mesenteric artery lymph node metastasis in cancer of the descending colon, sigmoid colon and rectum

“…In our study, we retrospectively compared the pathology-confirmed IMA-LN (+) cases, and no significant differences in prognosis were found between the high tie and low tie with LND strategies. This finding is similar to the results from Yasuda et al [16]. In our study, there were no data about low tie without LND because we routinely resect IMA-LNs.…”

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

“…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.…”

“…This debate goes all the way back to the descriptions by Miles14 and Moynihan15 in 1908. Recent studies7, 8, 9, 10 have recommended low tie, as there was no significant difference in survival rates between high‐ and low‐tie ligation.…”

Low ligation inferior mesenteric artery versus selective sigmoidal artery ligation in sigmoid colon cancer: a comparative study

“…3,4,12,16,17 This lead to the question of further selection ligation of the sigmoidal arteries in this study. In this study, the short-term outcomes were comparable to low-ligation IMA.…”

“…Many studies have accessed this issue by comparing results of high-tie versus low-tie with lymph node dissection of IMA and found similar oncologic outcomes. [2][3][4]12,16,17 The authors have further questioned on the clinical importance of location of vascular ligation. Only high-tie and low-tie have been compared.…”