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Meece MS, Davis JK, Ramsey WA, Galan DC, Castillo RP, Kutlu OC, Paluvoi NV. High Ligation of the Inferior Mesenteric Artery in Left-Sided Colon and Rectal Cancer Resection: Rates of Success and Outcomes. Am Surg 2024; 90:717-724. [PMID: 37878680 DOI: 10.1177/00031348231209531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND High ligation of the inferior mesenteric artery, defined as ligation before the takeoff of the left colic artery, is often described as the gold standard in low left-sided colon and rectal cancer surgery. The aim of this study is to quantify the rate of ligation at the described level at a single academic center. Additionally, we examined the relationship between level of ligation and cancer-related outcomes. METHODS This retrospective cohort study included patients ages 18 and over with low left-sided colon, rectal, and anal cancers undergoing surgical resection. Radiographic evidence of high ligation was defined as ligation of the inferior mesenteric artery before the takeoff of the left colic artery. Patients with and without radiographic evidence of high ligation on CT were compared. Secondary outcomes include lymph node yield and positivity, need for adjuvant therapy, and time from surgery to adjuvant therapy. RESULTS 169 patients (54% male) were included in the study. 61.5% of operative reports described high ligation of the IMA. There was radiographic evidence of high ligation in 55.6% of total patients and in 70.2% of patients where high ligation was intended. There was no significant difference in surgeon experience, surgical procedure, or surgical approach. There was no difference in lymph node yield, time to adjuvant chemotherapy, or recurrence rates. CONCLUSION This study demonstrates good technical success rate of high ligation of the inferior mesenteric artery but shows no difference in short-term patient-measured outcomes between high and low ligation (or successful and unsuccessful high ligation).
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Affiliation(s)
- Matthew S Meece
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Jenna K Davis
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Daniela C Galan
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - R Patricia Castillo
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Onur C Kutlu
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Nivedh V Paluvoi
- DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami Miller, Miami, FL, USA
- Jackson Memorial Hospital, Miami, FL, USA
- School of Medicine, University of Miami Miller, Miami, FL, USA
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Rutegård M, Svensson J, Segelman J, Matthiessen P, Lydrup ML, Park J. Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: A multicentre cohort study. Scand J Surg 2023; 112:246-255. [PMID: 37675547 DOI: 10.1177/14574969231181222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Some colorectal surgeons advocate routine splenic flexure mobilization (SFM) when performing anterior resection for rectal cancer to ensure a tension-free anastomosis. Meta-analyses of smaller studies suggest that this approach does not influence anastomotic leakage rates, but larger multicentre studies are needed to confirm the safety of a selective strategy. The aim of this study is to evaluate the impact of SFM on anastomotic leakage. METHODS This is a retrospective multicentre cohort study, comprising 1109 patients operated with anterior resection for rectal cancer in 2014-2018. Exposure was SFM, while anastomotic leakage within a year constituted the outcome. Stratified analyses were performed for type of mesorectal excision and surgical approach, as well as sensitivity analysis considering vascular tie placement. Multivariable Cox regression with hazard ratios (HRs) and 95% confidence intervals (CIs) was employed to adjust for confounding, while multiple imputation was used for missing data. RESULTS SFM was performed in 381 patients (34.4%). Anastomotic leakage occurred in 83 (21.8%) and 123 (20.3%) patients operated with and without SFM, respectively. SFM was neither clearly detrimental nor beneficial regarding anastomotic leakage (adjusted HR = 0.82; 95% CI: 0.59-1.15), with no apparent differences for total or partial mesorectal excision and minimally invasive or open surgery. Concurrent high vascular ligation did not impact these results, and there was no evidence of interaction from centers with a more common use of SFM. CONCLUSIONS SFM did not seem to influence the risk of anastomotic leakage after anterior resection for rectal cancer, regardless of type of mesorectal excision, use of minimally invasive surgery, or high vascular ligation.
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Affiliation(s)
- Martin Rutegård
- Department of Surgical and Perioperative Sciences, SurgeryUmeå UniversitySE-901 85 UmeåSwedenWallenberg Centre for Molecular MedicineUmeå UniversityUmeåSweden
| | - Johan Svensson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Josefin Segelman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Peter Matthiessen
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital and Lund University, Lund, Sweden
| | - Jennifer Park
- Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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