Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum: comparison of surgical and oncological outcomes with the open technique

Abstract

The post-surgical complications and oncological clearance of LRR done with low-tie IMA and selective D3 lymphadenectomy were found equivalent to ORR. Low-tie IMA without routine splenic flexure mobilisation had no technical issues regarding the anastomosis.

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

“…Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications, including leakage, stricture, or colon ischemia, which occurred in 10% of the patients [3]. To maintain favorable colon perfusion, low IMA ligation can be selected for preservation of the left colic artery (LCA) [45].…”

“…To date, the scope of clinical studies has been limited due to the difficulty in observing the colonic hypoperfusion status during surgery. Therefore, several different clinical studies have failed to reach a consensus for IMA ligation level and have reported contradictory results [567].…”

Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer

“…Moreover, dissection of apical lymph nodes does not necessarily imply a high tie, as the surgeon could choose to skeletonize the vessel up to the root of the IMA. Studies, mainly from Asia, have shown this to be a feasible technique, but have so far failed to show any benefit of this additional dissection 11,35–38 . The value of removing apical lymph nodes is not obvious either, as affected apical lymph nodes could simply be a surrogate marker for worse tumor biology.…”

“…Studies, mainly from Asia, have shown this to be a feasible technique, but have so far failed to show any benefit of this additional dissection. 11,[35][36][37][38] The value of removing apical lymph nodes is not obvious either, as affected apical lymph nodes could simply be a surrogate marker for worse tumor biology. Such an interpretation relies on the fact that disease-free 39 and overall 40 survival were worse in patients with positive apical lymph nodes, even when these were removed as part of curative surgery.…”

Selective sPlenic flExure mobilization for low colorEctal anastomosis after D3 lYmph node dissection (SPEEDY) trial: a study protocol

“…Several studies comparing high-tie with low-tie ligation reported a stage-specific survival benefit for high-tie; however, a recent study demonstrated that low-tie, without splenic flexure mobilization (SFM), decreased the complexity of the laparoscopic procedure and could reduce the operating time with comparable oncological outcomes. [ 3 ] During a radical paraaortic lymph node dissection, the inferior mesenteric artery (IMA) is usually ligated at its origin and the arcade of Riolan provides blood supply to proximal stump of the anastomosis. Unfortunately, the arcade of Riolan is an inconstant finding.…”