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Baik H. To go high, or to go low: the never-ending debate of inferior mesenteric artery ligation. Ann Coloproctol 2024; 40:1-2. [PMID: 38325809 PMCID: PMC10915534 DOI: 10.3393/ac.2024.00094.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- HyungJoo Baik
- Division of Colorectal Surgery, Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Ishimaru N, Tagami T, Takayasu K. Venous Congestive Ischemic Colitis After Sigmoid Colectomy: A Case Report. Cureus 2024; 16:e53880. [PMID: 38465067 PMCID: PMC10924825 DOI: 10.7759/cureus.53880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Venous congestion is a possible cause of ischemic colitis following colorectal surgery. As such, congestive ischemic colitis should be considered in such cases where the mesenteric artery is preserved. Herein, we describe the case of a 73-year-old man who presented to the hospital with a two-week history of difficult defecation and frequent mucous stools and was subsequently diagnosed with refractory ischemic enterocolitis due to venous congestion. The patient had undergone resection of the sigmoid colon cancer with preservation of the inferior mesenteric artery 11 months before presentation. Contrast-enhanced abdominal computed tomography revealed edematous wall thickening on the anal side of the anastomosis. A colonoscopy revealed a normal mucosa extending from the anastomosis to the descending colon; however, mucosal swelling, erythema, and erosion were observed on the rectal side of the anastomosis. Based on these findings, he was diagnosed with ischemic colitis. After two months of ineffective conservative treatment, the patient underwent surgery. Ischemic colitis was diagnosed as venous congestion based on the histopathological examination. Preservation of the mesenteric artery may result in ischemic colitis due to an imbalance between the arterial and venous blood flow. Chronic ischemic colitis due to venous congestion should be considered in cases of mesenteric artery preservation to reduce anastomotic leakage.
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Affiliation(s)
- Naoki Ishimaru
- Department of Surgery and Emergency Medicine, Suwa Central Hospital, Nagano, JPN
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, JPN
| | - Kohei Takayasu
- Department of Surgery, Suwa Central Hospital, Nagano, JPN
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Brillantino A, Skokowski J, Ciarleglio FA, Vashist Y, Grillo M, Antropoli C, Herrera Kok JH, Mosca V, De Luca R, Polom K, Talento P, Marano L. Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review. Cancers (Basel) 2023; 16:72. [PMID: 38201499 PMCID: PMC10777981 DOI: 10.3390/cancers16010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: "Is low tie ligation truly reproducible?" Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Jaroslaw Skokowski
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Francesco A. Ciarleglio
- Department of General Surgery and Hepato-Pancreato-Biliary (HPB) Unit—APSS, 38121 Trento, Italy;
| | - Yogesh Vashist
- Department Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Maurizio Grillo
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Carmine Antropoli
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Johnn Henry Herrera Kok
- Department of General and Digestive Surgery—Upper GI Unit, University Hospital of León, 24008 León, Spain;
| | - Vinicio Mosca
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy;
| | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Karol Polom
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland
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Ong SY, Tan ZZX, Teo NZ, Ngu JCY. Surgical considerations for the "perfect" colorectal anastomosis. J Gastrointest Oncol 2023; 14:2243-2248. [PMID: 37969832 PMCID: PMC10643590 DOI: 10.21037/jgo-23-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/17/2023] [Indexed: 11/17/2023] Open
Abstract
A technically sound colorectal anastomosis is paramount in optimising outcomes and reducing complications such as anastomotic leak which can lead to prolonged hospital stay, repeated operations, stoma formation, anastomotic stricture formation and even mortality in patients. Therefore, thorough consideration should be given to all aspects of its construct, from its basic mechanical configuration to subsequent evaluation of anastomosis integrity and perfusion. Risk factors for anastomotic leakage are well established and are usually classified into modifiable and non-modifiable risk factors. In this review article, we will focus on and discuss the modifiable surgical risk factors and how the authors incorporate latest evidence and surgical principles in creating a "perfect" colorectal anastomosis. We review the latest evidence on the proper mechanical construct of a colorectal anastomosis, enhanced recovery after surgery (ERAS), high versus low ligation of inferior mesenteric artery (IMA), routine splenic flexure mobilisation (SFM), the use of indocyanine green (ICG), as well as methods used for the evaluation of the anastomosis integrity. New adjuncts described in the literature to reinforce anastomoses are also discussed. In summary, meticulous technique with nuanced refinements based on our understanding of surgical principles, together with the adoption of relevant new technologies, are essential in our strive towards the "perfect" colorectal anastomosis.
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Affiliation(s)
- Suet Yan Ong
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - Zoe Zhuo Xuan Tan
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - Nan Zun Teo
- Department of Colorectal Surgery and General Surgery, Changi General Hospital, Singapore, Singapore
| | - James Chi Yong Ngu
- Department of Colorectal Surgery and General Surgery, Changi General Hospital, Singapore, Singapore
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Mann L, Preece R, Peacock M. Influence of splenic flexure mobilization on postoperative and oncological outcomes following anterior resection. Minerva Surg 2023; 78:497-502. [PMID: 36951678 DOI: 10.23736/s2724-5691.23.09859-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Splenic flexure mobilization (SFM) during anterior resection is often debated given its increased operative complexity and lack of clear data suggesting oncological benefit. This study aimed to compare postoperative complications and 3-year oncological outcomes in patients undergoing anterior resection with and without SFM. METHODS A retrospective single center observational study was performed. Notes review was performed for all patients undergoing anterior resection over a one-year period at a high-volume institution for sigmoid and rectal cancers. Anterior resections performed for benign disease or non-colorectal cancers were excluded. RESULTS One hundred seventeen patients were included and 49 (41.9%) underwent SFM. 75 (64.1%) cases were completed laparoscopically and 48 (41%) resulted in stoma formation. SFM significantly increased the risk of minor Clavien Dindo Grade 1 postoperative complications (18.4% vs. 5.9%, P=0.03), however, it had no impact on more major postoperative complications, including anastomotic leaks (4.2% vs. 7.1%, P=0.52). There were no significant differences in median total lymph node yield (21.0% vs. 21.1, P=0.57) or R0 resection margin (93.9% vs. 94.1%, P=0.96). There was a non-significant trend towards lower overall recurrence rates in the SFM group (10.2% vs. 19.1%, P=0.19). CONCLUSIONS In patients undergoing anterior resection for colorectal cancer, SFM provides no clear oncological benefit, but does increase the likelihood of minor postoperative complications. Whilst a trend towards lower overall recurrence rates was observed in the SFM group, this was not statistically significant. Therefore, SFM should be carefully considered on a case-by-case basis.
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Affiliation(s)
- Lydia Mann
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - Ryan Preece
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK -
| | - Mark Peacock
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK
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Crippa J, Santambrogio G, Spinelli A, Montroni I, Cirocchi R, Fingerhut A, Mari GM. 'Reply to: Exploring the potential appropriateness of high ligation for a specific demographic'. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106998. [PMID: 37543002 DOI: 10.1016/j.ejso.2023.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Jacopo Crippa
- Division of Colon & Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Antonino Spinelli
- Division of Colon & Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Isacco Montroni
- Colorectal Surgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Austria and Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, PR China
| | - Giulio M Mari
- Colorectal Surgery Unit, ASST Brianza, Desio Hospital, Desio, Italy
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Li Z, Zhou Y, Xu L, Xie L. Safety and efficacy of left colic artery preservation in laparoscopic anterior resection for lower rectal cancer. Future Oncol 2023; 19:1485-1494. [PMID: 37466013 DOI: 10.2217/fon-2023-0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background: To evaluate the safety and efficacy of left colic artery (LCA) preservation in laparoscopic anterior resection with D3 lymphadenectomy for lower rectal cancer. Methods: A total of 117 patients with lower rectal cancer who received laparoscopic anterior resection were retrospectively analyzed. Results: No differences were detected in terms of the numbers of harvested lymph nodes and metastatic lymph nodes, the intraoperative and postoperative complications or the postoperative recurrence and survival rates between the two groups (p > 0.05), but the LCA preservation group showed a lower anastomotic leakage rate than the LCA nonpreservation group (2/49 vs 12/68). Conclusion: LCA preservation may help reduce the incidence of anastomotic leakage without impairing surgical and oncological outcomes.
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Affiliation(s)
- Zonglin Li
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yejiang Zhou
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Linxia Xu
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lingling Xie
- Department of Gynaecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Treatment Center for Gynecologic & Breast Diseases (Gynecology), Luzhou, China
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Li Q, Wang Y, Wang JW, Qian L, Wang S, Cao TT, Xia YB, Huang XX, Xu L. Preserving or peeling the inferior mesenteric arterial sheath during laparoscopic rectal cancer surgery: a prospective study of surgical outcomes. BMC Surg 2023; 23:176. [PMID: 37370110 PMCID: PMC10303794 DOI: 10.1186/s12893-023-02083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND We mainly evaluated whether preserving the inferior mesenteric artery (IMA) sheath to dissecting IMA root lymph nodes (also called No.253 lymph nodes) would benefit patients in terms of comparable lymph-node yield removed during operation and postoperative complications in laparoscopic radical resection of rectal cancer. METHODS This is a prospective study included 141 rectal cancer patients who received laparoscopic radical resection during September 2018 to December 2020. All patients were randomly assigned to the preserved group (n = 71) and the peeled group (n = 70). The baseline characteristics, pathological features, intraoperative and postoperative data outcomes and complications were analyzed by independent samples t test, chi-square test or Fisher's exact test between the 2 groups. RESULTS The baseline characteristic and pathological features had no statistical difference between the 2 groups. The preserved group had a shorter operative time (P = 0.002), a shorter lymph node dissection time (P < 0.001), less intraoperative bleeding (P = 0.004), an earlier time to first flatus (P = 0.013), an earlier time to fluid intake (P = 0.033) and a shorter length of hospitalization (P = 0.012) than the peeled group. The differences between the 2 groups were not statistically significant (P > 0.05) in regard to the total number of lymph nodes cleared, positive lymph nodes, bleeding, anastomotic leakage, pneumonia, wound infection, abscess, ileus, urinary retention, urinary tract infection and chyle leakage. CONCLUSION Preserving of the IMA sheath in laparoscopic radical surgery for rectal cancer will reduce the total operation time and the length of hospitalization. This surgical method could lead to lower complication rate and faster recovery. TRIAL REGISTRATION The study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered by the China Clinical Trials Registry (ChiCTR2200060830, Date of Registration:2022-06-12 -retrospective registration) http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Qian Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Ye Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Jia-wei Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Long Qian
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Song Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Ting-ting Cao
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Ya-bin Xia
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Xiao-xu Huang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
| | - Li Xu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan West Road, Wuhu, Anhui, 241001 China
- Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution, Wuhu, Anhui China
- Non-coding RNA Research Center of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui China
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Mari G, Santambrogio G, Crippa J, Cirocchi R, Origi M, Achilli P, Ferrari G, Megna S, Desio M, Cocozza E, Maggioni D, Montroni I, Spinelli A, Zuliani W, Costanzi A, Crestale S, Petri R, Bicelli N, Pedrazzani C, Boccolini A, Taffurelli G, Fingerhut A. 5 year oncological outcomes of the HIGHLOW randomized clinical trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:641-646. [PMID: 36335077 DOI: 10.1016/j.ejso.2022.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The oncological outcomes of low ligation (LL) compared to high ligation (HL) of the inferior mesenteric artery (IMA) during low-anterior rectal resection (LAR) with total mesorectal excision are still debated. The aim of this study is to report the 5 year oncologic outcomes of patients undergoing laparoscopic LAR with either HL vs. LL of the IMA MATERIALS AND METHODS: Between June 2014 and December 2016, patients who underwent elective laparoscopic LAR + TME in 6 Italian non-academic hospitals were randomized to HL or LL of IMA after meeting the inclusion criteria (HighLow trial; ClinicalTrials.gov Identifier NCT02153801). We analyzed the rate of local recurrence, distant metastasis, overall survival, disease-specific survival, and disease-free survival at 5 years of patients previously enrolled. RESULTS Five-year follow up data were available for 196 patients. Recurrence happened in 42 (21.4%) of patients. There was no statistically significant difference in the distant recurrence rate (15.8% HL vs. 18.9% LL; P = 0.970) and pelvic recurrence rate (4,9% HL vs 3,2% LL; P = 0.843). No statistically significant difference was found in 5-year OS (p = 0.545), DSS (p = 0.732) or DFS (p = 0.985) between HL and LL. Low vs medium and upper rectum site of tumor, conversion rate, Clavien-Dindo post-operative grade ≥3 complications and tumor stage were found statistically significantly associated to poor oncological outcomes in univariate analysis; in multivariate analysis, however, only conversion rate and stage 3 cancer were found to be independent risk factors for poor DFS at 5 years. CONCLUSION We confirmed the results found in the previous 3-year survival analysis, the level of inferior mesenteric artery ligation does not affect OS, DSS and DFS at 5-year follow-up.
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Affiliation(s)
- Giulio Mari
- Colorectal Surgery Unit ASST Brianza, DesioHospital, Desio, Italy.
| | | | - Jacopo Crippa
- Division of Colon& Rectal Surgery, IRCCSHumanitasResearchHospital, Rozzano, Milan, Italy
| | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Matteo Origi
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Pietro Achilli
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Giovanni Ferrari
- General Surgery Department, Oncological and Mininvasive General Surgery, NiguardaHospital, Milano, Italy
| | - Stefano Megna
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Matteo Desio
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Eugenio Cocozza
- Varese General Surgery, Department of Surgery, ASST SetteLaghi, Italy
| | - Dario Maggioni
- Colorectal Surgery Unit ASST Brianza, DesioHospital, Desio, Italy
| | - Isacco Montroni
- ColorectalSurgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS, Rozzano-Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milano, Italy
| | - Walter Zuliani
- Humanitas Mater Domini ClinicalInstitute, General Surgery, Castellanza, Varese, Italy
| | - Andrea Costanzi
- General Surgery Unit, San Leopoldo Mandic Hospital, Merate, ASST Lecco, Italy
| | - Sara Crestale
- General Surgery Unit, San Leopoldo Mandic Hospital, Merate, ASST Lecco, Italy
| | - Roberto Petri
- General Surgery Unit, University Hospital, Udine, Italy
| | | | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Andrea Boccolini
- Department of General and Emergency Surgery AOSP of Terni, Italy
| | | | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, MedicalUniversity of Graz, Austria and Department of General Surgery, RuijinHospital, ShanghaiJiaoTongUniversitySchool of Medicine, Shanghai Minimally Invasive SurgeryCenter, Shanghai, 200025, PR China
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10
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Li B, Wang J, Yang S, Shen J, Li Q, Zhu Q, Cui W. Left colic artery diameter is an important factor affecting anastomotic blood supply in sigmoid colon cancer or rectal cancer surgery: a pilot study. World J Surg Oncol 2022; 20:313. [PMID: 36163068 PMCID: PMC9513983 DOI: 10.1186/s12957-022-02774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anastomotic blood supply is vital to anastomotic healing. The aim of this study was to demonstrate the effect of the left colic artery (LCA) on blood supply in the anastomotic area, explore the relationship between individual differences in the LCA and blood supply in the anastomotic area, and elucidate the relevant indications for LCA retention during radical resection for sigmoid or rectal cancer. METHOD Radical sigmoid or rectal cancer resection with LCA retention was performed in 40 patients with colorectal cancer who participated in this study. Systemic pressure, LCA diameter, and the distance from the root of the LCA to the root of the inferior mesenteric artery were measured and recorded. The marginal artery stump pressure in the anastomotic colon before and after the LCA clamping was measured, respectively. RESULTS There is a significant difference between the marginal artery stump pressure before LCA ligation and after ligation (53.1 ± 12.38 vs 42.76 ± 12.71, p < 0.001). The anastomotic blood supply positively and linearly correlated with body mass index and systemic pressure. Receiver-operating curve analysis revealed that LCA diameter (area under the curve 0.971, cutoff 1.95 mm) was an effective predictor of LCA improving anastomosis blood supply. No relationship was found between the LCA root location and anastomotic blood supply. CONCLUSION Preserving the LCA is effective in improving blood supply in the anastomotic area, and larger LCA diameters result in a better blood supply to the anastomotic area.
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Affiliation(s)
- Bo Li
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Jianan Wang
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Shaohui Yang
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Jie Shen
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Qi Li
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Qiqi Zhu
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China
| | - Wei Cui
- Department of Colorectal Surgery, Ningbo Medical Centre Lihuili Hospital, Ning Bo, 315000, China.
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