Technical difficulties of left colic artery preservation during left colectomy for colon cancer

Patroni, Alexia; Bonnet, Stéphane; Bourillon, Camille; Bruzzi, Matthieu; Zinzindohoué, Franck; Chevallier, Jean‐Marc; Douard, Richard; Berger, Anne

doi:10.1007/s00276-015-1583-8

Cited by 32 publications

(30 citation statements)

References 21 publications

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“…This did not significantly increase total operating time. Some studies30 31 have reported that an IMA branching pattern with a large distance between the origins of the IMA and LCA causes technical difficulty. It would appear that surgeons should not hesitate to change the tie level of the IMA when performing a difficult low‐tie ligation.…”

Section: Discussionmentioning

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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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%

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

et al. 2018

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“…In these cases, during dissection of the LCA, extreme caution should be taken, and ligation of the SMV was performed first in order to avoid any damage to the IMV. Although there is still uncertainty with regard to the technical difficulty of the procedure, Sekimoto et al[ 17 ] have demonstrated that compared to the high-tie technique, the low-tie procedure did not prolong the operating time and did not increase the amount of intraoperative bleeding. In the present study, compared with other previous studies on high ligation, the operating time was not prolonged significantly[ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although there is still uncertainty with regard to the technical difficulty of the procedure, Sekimoto et al[ 17 ] have demonstrated that compared to the high-tie technique, the low-tie procedure did not prolong the operating time and did not increase the amount of intraoperative bleeding. In the present study, compared with other previous studies on high ligation, the operating time was not prolonged significantly[ 17 , 18 ]. In addition, the incidence of postoperative complications was relatively low owing to the familiarity with anatomy and meticulous operation.…”

Section: Discussionmentioning

confidence: 99%

Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

Wang¹,

Cheng²,

Li³

et al. 2018

WJG

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AIMTo investigate the vascular anatomy of inferior mesenteric artery (IMA) in laparoscopic radical resection with the preservation of left colic artery (LCA) for rectal cancer.METHODSA total of 110 patients with rectal cancer who underwent laparoscopic surgical resection with preservation of the LCA were retrospectively reviewed. A 3D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery (SA) and superior rectal artery (SRA) was evaluated, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between inferior mesenteric vein (IMV) and LCA was also evaluated.RESULTSThree vascular types were identified in this study. In type A, LCA arose independently from IMA (46.4%, n = 51); in type B, LCA and SA branched from a common trunk of the IMA (23.6%, n = 26); and in type C, LCA, SA, and SRA branched at the same location (30.0%, n = 33). The difference in the length from the origin of IMA to LCA was not statistically significant among the three types. LCA was located under the IMV in 61 cases and above the IMV in 49 cases.CONCLUSIONThe vascular anatomy of the IMA and IMV is essential for laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.

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“…Laparoscopic rectal cancer surgery has been proven to have the same clinical results as traditional open surgery in terms of safety and e cacy [4,5]. During the laparoscopic low anterior resection of rectal cancer, the inferior mesenteric artery (IMA) can be treated in two ways: one is to identify and preserve the left colic artery (LCA) while ligating the IMA after the bifurcation of the left colic artery, the other is to ligate directly the root of the IMA without preserving the LCA [6].…”

Section: Introductionmentioning

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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Technical difficulties of left colic artery preservation during left colectomy for colon cancer

Cited by 32 publications

References 21 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

Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

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

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