Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a pilot study

Munechika, Taro; Kajitani, Ryuji; Matsumoto, Yoshiko; Nagano, Hideki; Komono, Akira; Aisu, Naoya; Morimoto, Mitsuaki; Yoshimatsu, Gumpei; Yoshida, Yoichiro; Hasegawa, Suguru

doi:10.1007/s00464-020-07556-x

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…Our results indicated that the LIMA group had signi cantly more patients with a distal margin of ≥ 15 cm than the PSRA group. Regarding anastomotic complications, few studies have reported no occurrence of anastomotic leakage in IMA ligation or SRA preservation for descending colon cancer [2,27]. However, in this study, postoperative anastomotic leakage occurred in two patients who underwent LIMA.…”

Section: Discussioncontrasting

confidence: 52%

“…When the IMA is ligated at the root, the blood supply to the remnant anal-side colon is considered to be preserved by up to approximately 10 cm from peritoneal re ection on the oral side [26]. In the study conducted by Munechika et al, indocyanine green (ICG) examination of the blood supply in IMA-root ligation revealed a distance of 17-66 cm from the peritoneal re ection to the ICG contrast limit [27].…”

Section: Discussionmentioning

confidence: 99%

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Short- and long-term outcomes of preservation of the superior rectal artery versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis

Sato

Imaizumi

Kasajima

et al. 2022

Preprint

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Purpose This study aimed to compare the short- and long-term outcomes of laparoscopic D3 lymph node (LN) dissection between ligation of the inferior mesenteric artery (IMA) (LIMA) and preservation of the superior rectal artery (SRA) (PSRA) for descending colon cancer using propensity score-matched analysis. Methods This retrospective study included 101 patients with stage I-III descending colon cancer who underwent laparoscopic D3 LN dissection with LIMA (n = 60) or PSRA (n = 41) at a single center between January 2005 and March 2022. After propensity score matching, 64 patients (LIMA, n = 32; PSRA, n = 32) were included in the analysis. The primary endpoint was the long-term outcomes, and the secondary endpoint was the surgical outcomes. Results In the matched cohort, no significant difference was noted in surgical outcomes, included the operative time, estimated blood loss, number of harvested LNs, number of harvested LN 253, and complication rate. The long-term outcomes were also not significantly different between the LIMA and PSRA groups (3-year recurrence-free survival: 78.7% vs. 88.9%, P = 0.335; 5-year overall survival: 69.8% vs. 63.4%, P = 0.888; 5-year cancer-specific survival: 84.2% vs. 82.8%, P = 0.607). No recurrence of LN metastasis was observed around the IMA root. Conclusion Laparoscopic D3 dissection in PSRA was comparable to that in LIMA regarding both short- and long-term outcomes. The optimal LN dissection for descending colon cancer should be investigated in future large-scale studies.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Short- and long-term outcomes of preservation of the superior rectal artery versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis

Sato

Imaizumi

Kasajima

et al. 2022

Preprint

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“…After dividing the blood perfusion from SMA, IMA was temporarily clamped and the blood flow from IIA was assessed by ICG. They demonstrated that the ICG fluorescence reached 17-66 cm from the peritoneal reflection and IMA high ligation was safely performed in all 20 cases without anastomotic leakage [11]. However, as our cases and…”

Section: Discussionmentioning

confidence: 47%

Intraoperative Indocyanine Green Imaging for the Evaluation of Blood Perfusion Area in Cancer of the Splenic Flexure With an Occluded Inferior Mesenteric Artery: A Report of Two Cases

Takahashi¹,

Kouno²,

Furuya³

et al. 2022

Cureus

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Radical resection for cancer of the splenic flexure requires careful consideration of the dissection line so that blood flow in the remnant bowel is maintained, particularly when the root of the inferior mesenteric artery (IMA) is already occluded. Intraoperative indocyanine green (ICG) imaging is a promising method for evaluating blood perfusion of organs and vessels. However, there are few reports on the use of ICG to determine the dissection line in patients with altered blood flow. In this article, we describe two cases of successful resection of splenic flexure cancer (SFC) in patients with an occluded IMA under ICG guidance.Case one was a 76-year-old man with a diagnosis of stage III SFC who had previously undergone endovascular aortic repair without reimplantation of the IMA. Intraoperative ICG imaging revealed that the left side of the colon was perfused mainly by the left branch of the middle colic artery (MCA). We performed a hemicolectomy with preservation of the MCA-left colic artery (LCA) arcade and resected an enlarged lymph node en bloc. Case two was a 77-year-old man with a diagnosis of stage II SFC in whom the root of the IMA appeared to be occluded by arteriosclerosis. Computed tomography showed that the LCA was anastomosed to the accessory middle colic artery (AMCA) while the left branch of the MCA was joined to the marginal artery. Intraoperative ICG imaging revealed that the left side of the colon was perfused by the AMCA and not the MCA. By preserving the AMCA-LCA arcade, we were able to safely divide the left branch of the MCA. Both patients were discharged with no symptoms of bowel ischemia or recurrence of cancer during follow-up.Interindividual variation in vessel branching patterns and dominant vessels in the descending and distal transverse colon may result from congenital factors or acquired disease. Detailed information on blood perfusion is required to avoid postoperative bowel ischemia. This report is the first to focus on patients with SFC and altered blood flow. We show that ICG imaging might be a reasonable option for determining an adequate surgical dissection area.

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“…ICG is a safe dye, and its adverse reactions are rarely reported ( 50 , 51 ). In a study of 1,226 participants, adverse events were observed in only eight subjects after intravenous ICG administration of 1 to 5 mg/kg, with only one severe adverse event and no deaths reported ( 52 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leakage in Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

Tang

Tao

et al. 2022

Front. Surg.

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BackgroundMeta-analyses have demonstrated that indocyanine green (ICG) can effectively prevent anastomotic leakage (AL) after colorectal surgery. However, recent evidence from large randomized controlled trial (RCT) has suggested that ICG fluorescence angiography does not reduce the incidence of AL in colorectal surgery. This study was conducted to evaluate the value of ICG for the prevention of AL following colorectal surgery.MethodsUp to September 16, 2021, PubMed, Embase, China National Knowledge Infrastructure, Web of Science, Scopus, Cochrane Library, and VIP databases were searched for RCTs and propensity-score matched (PSM) studies evaluating the use of ICG for prevention of AL after colorectal surgery. Mean differences (MDs) or odds ratios (ORs) and 95% confidence intervals (CI) were calculated.ResultsTwenty studies (5 RCTs and 15 PSM studies) with a total of 5,125 patients were included. ICG did not reduce the reoperation rate (OR, 0.71; 95% CI, 0.38, 1.30), conversion rates (OR, 1.34; 95% CI, 0.65, 2.78), or mortality (OR, 0.50; 95% CI, 0.13, 1.85), but ICG did reduce the incidence of AL (OR, 0.46; 95% CI, 0.36, 0.59) and symptomatic AL (OR, 0.48; 95% CI, 0.33, 0.71), and reduced the length of hospital stay (MD,−1.21; 95% CI,−2.06,−0.35) and intraoperative blood loss (MD,−9.13; 95% CI,−17.52,−0.74). In addition, ICG use did not increase the incidence of total postoperative complications (OR, 0.93; 95% CI, 0.64, 1.35), postoperative ileus (OR, 1.26; 95% CI, 0.53, 2.97), wound infection (OR, 0.76; 95% CI, 0.44, 1.32), urinary tract infection (OR, 0.87; 95% CI, 0.30, 2.59), pulmonary infection (OR, 0.23; 95% CI, 0.04, 1.45), urinary retention (OR, 1.08; 95% CI, 0.23, 5.04), anastomotic bleeding (OR, 1.53; 95% CI, 0.27, 8.60), anastomotic stricture (OR, 0.74; 95% CI, 0.24, 2.29), or operative time (MD,−9.64; 95% CI,−20.28, 1.01).ConclusionsICG can effectively reduce the incidence of AL, without prolonging the operation time or increasing postoperative complications in colorectal surgery.Systematic Review Registrationwww.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42021279064.

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Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a pilot study

Cited by 15 publications

References 12 publications

Short- and long-term outcomes of preservation of the superior rectal artery versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis

Short- and long-term outcomes of preservation of the superior rectal artery versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis

Intraoperative Indocyanine Green Imaging for the Evaluation of Blood Perfusion Area in Cancer of the Splenic Flexure With an Occluded Inferior Mesenteric Artery: A Report of Two Cases

Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leakage in Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

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