Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie

Girard, Édouard; Trilling, Bertrand; Rabattu, Pierre‐Yves; Sage, Pierre-Yves; Taton, N.; Robert, Y.; Chaffanjon, Philippe; Faucheron, Jean‐Luc

doi:10.1007/s10151-019-01931-0

Cited by 32 publications

(25 citation statements)

References 16 publications

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“…22,23 Maintaining blood supply and ensuring a tension-free anastomosis reduces the incidence of AL. 24 Preserving LCA in LT ensures adequate blood supply and oxygenation to the remaining colon. In contrast, the blood supply of the remaining distal colon in the case of HT solely depends on the middle colic and marginal arteries.…”

Section: Discussionmentioning

confidence: 99%

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Luo¹,

Yu²,

Huang³

et al. 2021

CMAR

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Background: Preservation of the left colic artery in low-tie (LT) of inferior mesenteric artery remains controversial compared to high-tie (HT) in the colon and rectal cancers, for lymph node dissection, anastomotic leakage, and oncological outcome. This cohort study aims to analyze short-and long-term outcomes of laparoscopic anterior resections in LT vs HT for rectal cancers. Methods: We analyzed a cohort of laparoscopic AR for RC from 2013 to 2016 at Renji Hospital, Shanghai, China. Short-and long-term outcome in LT vs HT group were compared for clinico-demographic characteristics, operative-time, lymph node dissection, short-term 30day outcome, and long-term 3-and 5-year overall survival as well as disease-free survival. The x 2 , t-test, and logistic regressions analysis were used and p<0.05 was considered significant. Results: The cohort consisted of 614 laparoscopic AR with LT (236) and HT (378). The clinicodemographic characteristics were comparable among the groups. The surgery took longer in LT. The yield of LND was similar. Leakage occurred in 12.21% (n=75). Leakage was fewer in LT than HT, 8.89% vs 14.28%, p=0.047. The postoperative severe complications were higher in HT. The 30-day mortality was nil. The long-term 3-and 5-year overall survival and disease-free survival were similar in LT and HT. Conclusion:The LT with preservation of left colic artery had similar lymph node yield, but lower leakage and complications than HT in laparoscopic anterior resections for rectal cancers. The long-term 3-and 5-year overall and disease-free survival were similar in the two groups.

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Section: Discussionmentioning

confidence: 99%

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Luo¹,

Yu²,

Huang³

et al. 2021

CMAR

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“…Excessive anastomotic tension and poor blood supply are important factors for anastomotic leakage [22]. High ligation of IMA can loosen the mesentery and make the proximal colon more free and drooping, theoretically reducing the tension between the colon and the anastomotic site of the rectum or anal canal [23].However, after the high ligation of IMA, the proximal colon could only supply blood from the middle colon artery from the superior mesenteric artery, the blood perfusion of the marginal arterial arch was reduced, and the blood supply of the terminal colon was deteriorated [24].…”

Section: Discussionmentioning

confidence: 99%

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Luo¹,

Li²,

Wu³

et al. 2020

Preprint

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Aim To analyze the effect of preserving the left colic artery (LCA) on long-term oncologic outcomes during laparoscopic low anterior resection of rectal cancer. Methods Clinicopathological and follow-up patients undergoing laparoscopic low anterior resection of rectal cancer in general surgery department of Guangdong Provincial People's Hospital from January 2014 to December 2015 were retrospectively collected. According to the difference surgical methods of inferior mesenteric artery (IMA), 159 cases were divided into the LCA preservation group and 225 cases in the LCA non-preservation group. The 5-year rates of overall survival (OS) and disease-free survival (DFS) were compared between two group. Results 384 patients were included in final analysis. Anastomotic leakage occurred in 7 patients (4.4%) in the LCA preservation group and in 16 patients (7.1%) in the LCA non-preservation group. The follow-up rate was 91.2% (145/159) during 5–60 months in LCA preservation group, and 89.8% (202/225) during 5–60 months in the LCA non-preservation group. The number of patients who developed death, local recurrence and metastasis were 59 (37.1%), 13 (8.2%) and 60 (37.7%) in the LCA preservation group, and 86 (38.2%), 20 (8.9%) and 92 (40.9%) in the LCA non-preservation group, without significant differences (all P ༞ 0.05). The 5-year OS and DFS rates were 69.0% and 59.3% in the LCA preservation group, and 68.8% and 55.9% in the LCA non-preservation group, without significant differences (all P ༞ 0.05). After stratification by TNM Stage, the difference on 5-year OS rates and DFS rates of I stage, II stage and III stage in two groups were no significant as well (all P ༞ 0.05). Conclusions The long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the LCA are comparable with ligation at origin of IMA.

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“…In this case, the relatively lower position of the anastomosis stoma may make the tension of the intestine a more dominant factor of anastomosis [49]. The conservation of the LCA would decrease the mobility of the proximal intestine by approximately 6-9 cm, which could increase the tension of the anastomotic stoma [50,51], and this may balance out the bene t of better blood supply. Besides, a protective stoma of the distal ileum was more common in radical surgery for mid-low RC, which would also in uence the diagnosis of anastomosis leakage [52].…”

Section: Discussionmentioning

confidence: 99%

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

Wang

et al. 2020

Preprint

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Background: Left colic artery (LCA) preservation or non-preservation in radical resection for colorectal cancer is still under debate. This study aimed to compare the perioperative and oncological outcomes between the two procedures.Methods: Systematic search was performed in PubMed, Medline, Embase, Web of Science, and China National Knowledge Infrastructure databases for relevant randomized and non-randomized clinical trials published between 2011 and 2019. The primary endpoints were 5-year overall survival (OS), 5-year disease-free survival (DFS), total lymph nodes harvested, and anastomotic leakage. Secondary endpoints included the number of metastatic lymph nodes, intraoperative blood loss, urinary dysfunction, bowel obstruction, and operation time. Results: Twenty-eight studies with 10545 patients (LCA non-preservation surgery, 4920; LCA preservation surgery, 5625) were included. Data of 7142 rectal cancer patients (LCA non-preservation surgery, 3468; LCA preservation surgery, 3674) were extracted for subgroup analysis. There was significantly lower incidence of anastomotic leakage (odds ratio=1.21; 95% confidence interval |1.04, 1.41|; P=0.015) in colorectal cancer patients with LCA preservation. When rectal cancer was independently analyzed, no significant difference was found in anastomotic leakage between the groups. There were significantly more metastatic lymph nodes and significantly shorter operation time in colorectal cancer and rectal cancer patients with LCA non-preservation. No significant difference was found regarding 5-year OS, 5-year DFS, total lymph nodes harvested, intraoperative blood loss, urinary dysfunction, and bowel obstruction for colorectal and rectal cancer.Conclusions: LCA non-preservation was not proved to increase anastomotic leakage in rectal cancer surgery and was associated with more harvested metastatic lymph nodes and shorter operation time. Trial registration: A review protocol was registered on PROSPERO (registration number: CRD42020183906) and http://www.researchregistry.com (registration number: reviewregistry841).

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Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie

Cited by 32 publications

References 16 publications

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

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