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Ide T, Shimamura K, Kuratani T, Shijo T, Sakaniwa R, Watanabe Y, Maeda K, Masada K, Yamashita K, Matsumoto R, Miyagawa S. Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair. J Endovasc Ther 2024; 31:371-380. [PMID: 36120997 DOI: 10.1177/15266028221121748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE The impact of preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. MATERIALS AND METHODS In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. Endovascular aneurysm repairs performed using a commercially available device with no type I or type III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and the occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, reintervention, and mortality rates, were compared between both groups using propensity-score-matched data. RESULTS After propensity score matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32-94 months). The incidence of type II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p<0.001). The type II EL from IMA and lumbar arteries was significantly higher in the patent IMA group than in the occluded IMA group (p<0.001 and p=0.002). The rate of freedom from aneurysm sac enlargement with type II EL was significantly higher in the occluded IMA group than in the patent IMA group (94% vs 69% at 7 years; p<0.001). The rate of freedom from reintervention was significantly higher in the occluded IMA group than in the patent IMA group (90% vs 74% at 7 years; p=0.007). Abdominal aortic aneurysm-related death and all-cause mortality did not significantly differ between groups (p=0.32 and p=0.34). CONCLUSIONS Inferior mesenteric artery patency could affect late reintervention and aneurysm sac enlargement but did not have a significant impact on mortality. Preoperative assessment and embolization of IMA might be an important factor for improvement in late EVAR outcomes. CLINICAL IMPACT The preoperative patency of the inferior mesenteric artery was significantly associated with a higher incidence of sac enlargement and reintervention with type II endoleak following endovascular aneurysm repair, even after adjustment for patient background. Preoperative assessment and embolization of inferior mesenteric artery might be an important factor for improvement in late EVAR outcomes.
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Affiliation(s)
- Toru Ide
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Watanabe
- Department of Cardiovascular Surgery, Kinan Hospital, Tanabe, Japan
| | - Koichi Maeda
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Goksoy B. Nerve-Sparing High Ligation of the Inferior Mesenteric Artery in Laparoscopic Colorectal Surgery. Dis Colon Rectum 2024; 67:e295-e296. [PMID: 38319725 DOI: 10.1097/dcr.0000000000003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Beslen Goksoy
- Department of General Surgery, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fadel G, Ben Abdallah I. Inferior Mesenteric Artery Preservation in Aorto-Iliac Recanalisation: Wise or Excessive? Eur J Vasc Endovasc Surg 2024; 67:610. [PMID: 37951385 DOI: 10.1016/j.ejvs.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Guillaume Fadel
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Université Paris Cité, Paris, France.
| | - Iannis Ben Abdallah
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, Université Paris Cité, Paris, France
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Dimitriadis K, Karanikas M, Malafi ME, Parisidis S, Georgakarakos E. Open Management of an Asymptomatic 4.2 Cm Middle Colic Artery Aneurysm and Liteture Review. Vasc Endovascular Surg 2024; 58:338-342. [PMID: 37908141 DOI: 10.1177/15385744231213297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Aneurysms of the middle colic artery (MCAA) and its branches are exceedingly rare accounting for <3% of total visceral aneurysms. Very few MCAA cases have been reported in the literature with only three cases accounting for a diameter >4 cm. METHOD We describe the successful open repair with ligation of a 4.2 cm asymptomatic MCAA in a female patient through the gastrohepatic ligament taking meticulous caution to avoid injury of the pancreas. The postoperative period was uneventful and the patient was discharged from the hospital on the fifth postoperative day. At 1 month follow-up the postoperative computed tomographic angiography documented complete exclusion of the MCAA and absence of contrast agent in the sac both in the arterial and the venous phase. CONCLUSION While the endovascular treatment is the first-line option for visceral aneurysms, the open approach is still reserved for certain cases of hostile anatomy, challenging location and large size. Our case highlights the irreplaceable role of open surgery and underlines the collaboration between surgical specialties.
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Affiliation(s)
- Konstantinos Dimitriadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michail Karanikas
- First General Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Eleni Malafi
- Department of Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Parisidis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Xu C, Huang Q, Hu Y, Ye K, Xu J. A nomogram for predicting lymph nodes metastasis at the inferior mesenteric artery in rectal cancer: a retrospective case-control study. Updates Surg 2024; 76:513-520. [PMID: 38245891 PMCID: PMC10995043 DOI: 10.1007/s13304-023-01748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
According to past and current literature, metastasis of the lymph nodes at the inferior mesenteric artery (IMA-LN), also known as 253LN of colorectal cancer has been seldom investigated. To date, there are still controversies on whether the 253LN need to be routinely cleaned. Using specific criteria, 347 patients who underwent radical resection for rectal cancer between April 2019 and July 2022 were selected for the study. Logistic regression was used to determine the likelihood that a patient may suffer 253LN metastasis, and a nomogram for 253LN metastasis subsequently developed. The c-index and calibration curve were used to evaluate precision and discrimination in the nomogram, and the appropriateness of the final nomogram for the clinical setting determined using decision curve analysis (DCA). 253LN metastases appeared in the pathological specimens of 29 (8.4%) of the selected patients. Logistic regression showed that preoperative parameters including serum carcinoembryonic antigen (CEA) value ( > 5 ng / ml, OR = 2.894, P = 0.023), distance from anal margin (> 9 cm, OR = 2.406, P = 0.045) and degree of differentiation (poor, OR = 9.712, P < 0.001) were significantly associated with 253LN metastasis. A nomogram to predict 253LN metastasis in rectal cancer was developed and showed considerable discrimination and good precision (c-index = 0.750). Furthermore, DCA confirmed that the nomogram has some feasibility for the clinical environment. Clinicopathological and radiological patient data can be pivotal for making surgical decisions relating to 253LN metastasis. A nomogram was developed using this data, providing an objective method that can significantly improve prognoses in colorectal cancer.
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Affiliation(s)
- Chunhao Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Qiaoyi Huang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Yunhuang Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China.
| | - Jianhua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China.
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Ding Y, Zhao B, Niu W, Hu X, Li C, Liu Z, Yu B. Assessing anatomical variations of the inferior mesenteric artery via three-dimensional CT angiography and laparoscopic colorectal surgery: a retrospective observational study. Sci Rep 2024; 14:6985. [PMID: 38523142 PMCID: PMC10961314 DOI: 10.1038/s41598-024-57661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
To assess the anatomy of the inferior mesenteric artery (IMA) and its branches by reviewing laparoscopic left-sided colorectal cancer surgery videos and comparing them with preoperative three-dimensional computed tomography (3D-CT) angiography, to verify the accuracy of 3D-CT vascular reconstruction techniques. High-definition surgical videos and preoperative imaging data of 200 patients who underwent laparoscopic left-sided colorectal cancer surgery were analysed, and the alignment of the IMA and its branches in relation to the inferior mesenteric vein (IMV) was observed and summarized. The above two methods were used to measure the length of the IMA and its branches. Of 200 patients, 47.0% had the sigmoid arteries (SAs) arise from the common trunk with the superior rectal artery (SRA), and 30.5% had the SAs arise from the common trunk with the left colic artery (LCA). In 3.5% of patients, the SAs arising from both the LCA and SRA. The LCA, SA, and SRA emanated from the same point in 13.5% of patients, and the LCA was absent in 5.5% of patients. The range of D cm (IMA length measured by intraoperative silk thread) and d cm (IMA length measured by 3D-CT vascular reconstruction) in all cases was 1.84-6.62 cm and 1.85-6.52 cm, respectively, and there was a significant difference between them. (p < 0.001). The lengths between the intersection of the LCA and IMV measured intraoperatively were 0.64-4.29 cm, 0.87-4.35 cm, 1.32-4.28 cm and 1.65-3.69 cm in types 1A, 1B, 1C, and 2, respectively, and there was no significant difference between the groups (p = 0.994). There was only a significant difference in the length of the IMA between the 3D-CT vascular reconstruction and intraoperative observation data, which can provide guidance to surgeons in preoperative preparation.
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Affiliation(s)
- Yuanyi Ding
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Botian Zhao
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Wenbo Niu
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Xuhua Hu
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Chenhui Li
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Zining Liu
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Bin Yu
- The Second Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang, Hebei, People's Republic of China.
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Chew DK, Schmelter RA, Tran MT, Franko J. Reducing aneurysm sac growth and secondary interventions following endovascular abdominal aortic aneurysm repair by preemptive coil embolization of the inferior mesenteric artery and lumbar arteries. J Vasc Surg 2024; 79:532-539. [PMID: 38008267 DOI: 10.1016/j.jvs.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Type II endoleak (EL-2) is the most common complication following endovascular aneurysm repair (EVAR), leading to continued sac growth and potential rupture. In this study, we examined the association between patency of the inferior mesenteric artery (IMA) and lumbar arteries (LAs) with respect to sac growth. The effect of preemptive embolization of the IMA and/or LAs on the need for secondary interventions for sac growth post-EVAR was also evaluated. METHODS A retrospective cohort study was performed on consecutive patients who underwent EVAR for non-ruptured, infrarenal abdominal aortic aneurysms (AAAs) from January 2012 to December 2020. A select group of patients underwent preemptive embolization of the IMA and/or LA. Patients with any types I, III, or IV endoleaks were excluded. Patency of the IMA and LA on preoperative computed tomography angiogram (CTA) was evaluated on TeraRecon workstation. All secondary interventions to treat EL-2 were recorded. Sac growth was defined as centerline axial diameter increase of ≥5 mm on follow-up CTA. RESULTS A total of 300 patients (mean age, 74 ± 8.5 years; 83.7% male) underwent EVAR. Ninety-nine patients had preemptive embolization of the IMA and/or LA. Mean follow-up of the cohort was 59.3 ± 30.5 months. Thirty-six patients (12%) demonstrated sac growth on follow-up; 12 of these (33.3%) had preemptive embolization. The median time until detection of sac growth was 28.8 months (interquartile range, 15.2-46.5 months), with a mean growth of 10.1 ± 6.4 mm. Sac growth was significantly associated with presence of EL-2: 27 of 36 (75%) with EL-2 vs 9 of 36 (25%) without EL-2 (P < .001). Patients with sac growth had a higher mean total number (2.6 ± 1.5) of patent lower LAs (L3, L4) compared with those without (2.0 ± 1.4; P = .03). Patency of L1, L2, and L3 LAs were not associated with sac growth. However, patency of at least one L4 LA was significantly associated with sac growth (14.8% vs 7.7%; P = .04). The highest incidence of sac growth (17.6%) was seen when both IMA and L4 LA were patent; significantly different from the lowest incidence (5.3%) when both were occluded preoperatively (P = .018). Preemptive coiling of the IMA and/or LA significantly reduced the need for post-EVAR secondary intervention for sac growth. Freedom from post-EVAR secondary intervention was achieved in 92 of 99 (92.9%) pre-EVAR coiled patients vs 163 of 201 (81.5%) patients who did not undergo pre-EVAR coiling (P = .009). CONCLUSIONS Preemptive coil embolization of the IMA and LAs, especially L4 LA, reduces the need for secondary interventions for sac growth, potentially improving the long-term durability of EVAR.
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Affiliation(s)
- David K Chew
- MercyOne Medical Center, Des Moines, IA; Iowa Heart Center, Des Moines, IA.
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Balaban V, Vasilyev A, Nekoval V, Tsarkov P. D2 lymph node dissection and preservation of the superior rectal artery for mid-sigmoid colon cancer. Asian J Surg 2024; 47:1272-1273. [PMID: 38030500 DOI: 10.1016/j.asjsur.2023.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Vladimir Balaban
- Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia.
| | - Alexander Vasilyev
- Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia
| | - Valery Nekoval
- Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia
| | - Petr Tsarkov
- Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov University, Russia
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Wang X, Li J, Chen W, Yang Q. Preserving the left colonic artery in radical sigmoid and rectal cancer surgery is feasible: A meta-analysis. Medicine (Baltimore) 2024; 103:e37026. [PMID: 38277569 PMCID: PMC10817117 DOI: 10.1097/md.0000000000037026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND This study aims to investigate the safety and feasibility of preserving left colonic artery (LCA) in radical sigmoid and rectal cancer surgery. METHODS Relevant articles were systematically searched on the PubMed, Embase, and Cochrane Library. The quality of included studies was evaluated using the Cochrane Handbook. A meta-analysis was conducted to assess the surgical outcomes and oncological outcomes by RevMan 5.4 software. RESULTS Fifteen studies with a total of 5054 patients, including 2432 patients with LCA preservation and 2622 patients without LCA preservation, were included and analyzed in this study. The meta-analysis revealed that preserving LCA in radical surgery of sigmoid and rectal cancer has lower anastomotic leakage incidence (OR = 1.03, 95% confidence interval = 0.83-1.27, P < .0001). There were no significant differences in the operative time, intraoperative blood loss, number of dissected lymph nodes, postoperative complications as well as the oncological outcomes including systemic recurrence, local recurrence, 5-year overall survival rate, and 5-year disease-free survival rate. CONCLUSION SUBSECTIONS This pooled analysis showed that preserving the LCA is safe and feasible in radical sigmoid and rectal cancer surgery.
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Affiliation(s)
- Xin Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Jianxin Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Wangsheng Chen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Qingqiang Yang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
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Di Nuzzo MM, Boccia G, Visconti M, Magno G, Bracale U, Corcione F. Totally laparoscopic management of inferior mesenteric artery injuries in colorectal surgery - a video vignette. Colorectal Dis 2023; 25:2459-2460. [PMID: 37872847 DOI: 10.1111/codi.16777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023]
Affiliation(s)
| | - Giuseppe Boccia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Marco Visconti
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giuseppe Magno
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Zeng H, Lan Q, Li F, Xu D, Lin S. Comparison of the short-term and long-term outcomes of three different types of inferior mesenteric artery ligation in left colonic and rectal cancers: a network meta-analysis. Updates Surg 2023; 75:2085-2102. [PMID: 37715053 DOI: 10.1007/s13304-023-01631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Abstract
To perform a network meta-analysis of the literature to assess the short-term and long-term outcomes of three operations for left colon and rectal cancer. Electronic literature searches were performed in the PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials databases up to August 2022. A Bayesian network meta-analysis using R software, ADDIS, and Review Manager 5.4 was conducted to compare outcomes of high ligation of the inferior mesenteric artery(IMA),low ligation of the IMA with D2 dissection (LLD2), and low ligation of the IMA with D3 dissection (LLD3). Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Asymmetry of data was estimated by using Egger's tests. Publication bias corrected by trimming and filling method. A total of 44 studies, 5 randomized clinical trials (RCTs) and 39 non-RCTs, were included in this meta-analysis. HL was associated with a higher risk of anastomotic leakage (HL vs. LLD2, OR = 1.35, 95% CI 1.13-3.25, P = 0.001; HL vs. LLD3, OR = 1.65, 95% CI 1.35-2.01, P < 0.001), and required a longer postoperative hospital stay (HL vs. LLD3, SMD = 0.28, 95%CI 0.09-0.48, P = 0.01).However HL showed an advantage in terms of operation time(HL vs. LLD3, SMD = - 0.13, 95%CI - 0.26 to 0.01, P = 0.04). LLD3 is most likely to rank best in terms of short-term and long-term outcomes after surgery for left colon and rectal cancer. Caution should be taken in the risk of anastomotic leakage when treating colorectal cancer with LLD2. HL, LLD2 and LLD3 provide similar overall survival rates for left colon and rectal cancer.
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Affiliation(s)
- Hao Zeng
- Fujian Medical University, Fuzhou, People's Republic of China
| | - Qilong Lan
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, Fujian, 364000, People's Republic of China
| | - Fudi Li
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, Fujian, 364000, People's Republic of China
| | - Dongbo Xu
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, Fujian, 364000, People's Republic of China
| | - Shuangming Lin
- Department of Gastroenterology and Anorectal Surgery, Longyan First Hospital, Fujian Medical University, 105, Jiuyi North Road, Longyan, Fujian, 364000, People's Republic of China.
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13
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Maruta H, Tominaga T, Nonaka T, Hisanaga M, Takeshita H, Fukuoka H, To K, Tanaka K, Sawai T, Nagayasu T. Efficacy of left colic artery preservation with D3 lymph node dissection in laparoscopic surgery for advanced sigmoid and rectal cancer. Surg Today 2023; 53:1335-1342. [PMID: 37072524 DOI: 10.1007/s00595-023-02689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/24/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE For advanced left colon cancer, lymph node dissection at the root of the inferior mesenteric artery is recommended. Whether the left colic artery (LCA) should be preserved or resected remains contentious. METHODS The 367 patients who underwent laparoscopic sigmoidectomy or anterior resection and who were pathologically node-positive were reviewed. Patients were divided into LCA-preserving group (LCA-P, n = 60) and LCA-non-preserving group (LCA-NP, n = 307). Propensity score matching was applied to minimize selection bias and 59 patients were matched. RESULTS Before matching, the rates of poor performance status and cardiovascular disease were higher in the LCA-P group (p < 0.001). After matching, operation time was longer (276 vs. 240 min, p = 0.001), the frequency of splenic flexure mobilization (62.7% vs. 33.9%, p = 0.003) and lymphovascular invasion (84.7% vs. 55.9%, p = 0.001) was higher in the LCA-P group. Severe postoperative complications (CD ≥ 3) occurred only in the LCA-NP group (0% vs. 8.4%, p = 0.028). The median follow-up period was 38.5 months (range 2.0-70.0 months). The 5-year RFS rates (67.8% vs. 66.0%, p = 0.871) and OS rates (80.4% vs. 74.9%, p = 0.308) were comparable between the groups. CONCLUSIONS Laparoscopic LCA-sparing surgery for left-sided colorectal cancer reduces the risk of severe complications and offers a favorable long-term prognosis.
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Affiliation(s)
- Hiroshi Maruta
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | - Kazuo To
- Department of Surgery, Ureshino Medical Center, Ureshino, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Saiseikai, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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14
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Zhang JW, Sun Y. Preservation versus non-preservation of left colic artery during laparoscopic radical operation for sigmoid colon cancer. Asian J Surg 2023; 46:5014-5015. [PMID: 37743179 DOI: 10.1016/j.asjsur.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Jun-Wei Zhang
- Department of General Surgery, ZiGong Third People's Hospital, Zigong, 643000, China.
| | - Yi Sun
- Department of General Surgery, The People's Hospital of SND, SuZhou, 215000, China.
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15
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Wang A, Zhang P, Bian C, Zhou H. Bleeding at the root of the inferior mesenteric artery during robotic D3 lymph node dissection for rectal cancer - a video vignette. Colorectal Dis 2023; 25:2109-2110. [PMID: 37568275 DOI: 10.1111/codi.16699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/02/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Anqi Wang
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Peng Zhang
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Ce Bian
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Haiyang Zhou
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
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16
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Furukawa S, Hiraki M, Akashi M, Kimura N, Takahashi Y, Samejima R. Laparoscopic surgery for rectal cancer with a coexisting Retzius shunt and inferior mesenteric arteriovenous malformation: A case report. Asian J Endosc Surg 2023; 16:761-765. [PMID: 37340515 DOI: 10.1111/ases.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
A coexisting short-circuit from the inferior mesenteric vein (IMV) to the inferior vena cava, known as a Retzius shunt, and arteriovenous malformation (AVM) of the inferior mesentery are extremely rare conditions. We encountered a case of rectal cancer with coexisting Retzius shunt and inferior mesenteric AVM successfully treated with laparoscopic surgery. Contrast computed tomography (CT) in a 62-year-old man with rectal cancer showed multiple dilated veins at the mesenterium of the descending sigmoid colon. These dilated veins were connected between the IMV and the left renal vein. A diagnosis of Retzius shunt was made, and laparoscopic low anterior resection with lymph node dissection was performed. A pathological examination of the colonic mesenterium revealed AVM communicating with the dilated IMV and Retzius shunt. The preoperative evaluation of aberrant vessels by three-dimensional CT is particularly useful for patients with vascular malformations to ensure safe laparoscopic surgery.
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Affiliation(s)
- Shunsuke Furukawa
- Department of Surgery, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
| | - Masatsugu Hiraki
- Department of Surgery, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
| | - Michiaki Akashi
- Department of Pathology, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
| | - Naoya Kimura
- Department of Surgery, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
| | - Yukihiko Takahashi
- Department of Radiology, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
| | - Ryuichiro Samejima
- Department of Surgery, Japanese Red Cross Society Karatsu Red Cross Hospital, Karatsu, Japan
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17
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Silvestri V, Pontecorvi E, Sciuto A, Pacella D, Peltrini R, D'Ambra M, Lionetti R, Filotico M, Lauria F, Sarnelli G, Pirozzi F, Ruotolo F, Bracale U, Corcione F. Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes-a prospective non-randomized controlled trial. Updates Surg 2023; 75:1569-1578. [PMID: 37505437 DOI: 10.1007/s13304-023-01593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
Vascular approach during elective laparoscopic left colectomy impacts post-operative outcomes. The aim of our study was to evaluate how different approaches impact positively defecatory, urinary and sexual functions and quality of life during elective laparoscopic left colectomy. A prospective non-randomized controlled trial at two tertiary center was conducted. All patients who underwent elective laparoscopic left colonic resection from January 2019 to July 2022 were analyzed. They were divided into two groups based on Inferior Mesenteric Artery (IMA) preservation with distal ligation of sigmoid branches close to a colonic wall for complicated diverticular disease and IMA high tie ligation for oncological disease. Patients were asked to fulfil standardized, validated questionnaires to evaluate pre and post-operative defecatory, urinary and sexual functions and quality of life. Defecatory disorders were assessed by high-resolution anorectal manometry preoperatively and six months after surgery. A total of 122 patients were included in the study. The 62 patients with IMA preservation showed a lower incidence of defecatory disorders also confirmed by manometer data, minor incontinence and less lifestyle alteration than the 60 patients with IMA high tie ligation. No urinary disorders such as incomplete emptying, frequency, intermittence or urgency were highlighted after surgery in the IMA preservation group. Evidence of any sexual disorders remained controversial. The IMA-preserving vascular approach seems to be an effective strategy to prevent postoperative functional disorders. It is a safe and feasible technique especially for diverticular disease. New prospective randomized and highly probative studies are needed to confirm the effectiveness in specific clinical situations.
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Affiliation(s)
- Vania Silvestri
- Department of General Surgery, SS Annunziata Hospital, 67039, Sulmona, L'Aquila, Italy.
| | - Emanuele Pontecorvi
- Department of General Surgery, SS Annunziata Hospital, 67039, Sulmona, L'Aquila, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, 80078, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Marcello Filotico
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Federica Lauria
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131, Naples, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, 80078, Naples, Italy
| | | | - Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084, Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
- Department of General Surgery, Clinica Mediterranea, 80122, Naples, Italy
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Huang X. Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer after neoadjuvant therapy - a video vignette. Colorectal Dis 2023; 25:1738-1740. [PMID: 37400968 DOI: 10.1111/codi.16648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/27/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Xing Huang
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
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19
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Cirocchi R, Marchetti F, Mari G, Bagolini F, Cavaliere D, Avenia S, Anania G, Tebala G, Donini A, Davies RJ, Fingerhut A. Inferior mesenteric artery ligation level in rectal cancer surgery: still no answer-a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:286. [PMID: 37493853 PMCID: PMC10371924 DOI: 10.1007/s00423-023-03022-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA) ligation on post-operative and oncological outcomes in rectal cancer surgery. METHODS We conducted a systematic review of the literature up to 06 September 2022. Included were RCTs that compared patients who underwent high (HL) vs. anterior (LL) IMA ligation for resection of rectal cancer. The literature search was performed on Medline/PubMed, Scopus, and the Web of Science without any language restrictions. The primary endpoint was overall anastomotic leakage (AL). Secondary endpoints were oncological outcomes, intraoperative complications, urogenital functional outcomes, and length of hospital stay. RESULTS Eleven RCTs (1331 patients) were included. The overall rate of AL was lower in the LL group, but the difference was not statistically significant (RR 1.43, 95% CI 0.95 to 2.96). The overall number of harvested lymph nodes was higher in the LL group, but the difference was not statistically significant (MD 0.93, 95% CI - 2.21 to 0.34). The number of lymph nodes harvested was assessed in 256 patients, and all had a laparoscopic procedure. The number of lymph nodes was higher when LL was associated with lymphadenectomy of the vascular root than when IMA was ligated at its origin, but there the difference was not statistically significant (MD - 0.37, 95% CI - 1.00 to 0.26). Overall survival at 5 years was slightly better in the LL group, but the difference was not statistically significant (RR 0.98, 95% CI 0.93 to 1.05). Disease-free survival at 5 years was higher in the LL group, but the difference was not statistically significant (RR 0.97, 95% CI 0.89 to 1.04). CONCLUSIONS There is no evidence to support HL or LL according to results in terms of AL or oncologic outcome. Moreover, there is not enough evidence to determine the impact of the level of IMA ligation on functional outcomes. The level of IMA ligation should be chosen case by case based on expected functional and oncological outcomes.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | | | - Giulio Mari
- Department of Colorectal Surgery ASST Brianza, Desio Hospital, Desio, Italy
| | | | - Davide Cavaliere
- Department of Colorectal Surgery and General Surgery, Ospedale Per Gli Infermi, Faenza, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Anania
- Department of Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, Hospital of Santa Maria of Terni, Terni, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Richard Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, China
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
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20
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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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21
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Wang Y, Wang L, Liang M, Xu Z, Xue Y, Liu G. Verification of blood flow path reconstruction mechanism in distal sigmoid colon and rectal cancer after high IMA ligation through preoperative and postoperative comparison by manual subtraction CTA. Eur J Surg Oncol 2023; 49:1269-1274. [PMID: 36658053 DOI: 10.1016/j.ejso.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We aimed to investigate manual subtraction computed tomography angiography (MS-CTA) to further confirm the distribution and classification of LCA (left colic artery) ascending/descending branches, then observe the postoperative blood flow path to illustrate how the above branches evolved to postoperative blood path. MATERIAL AND METHODS 89 patients with distal sigmoid and rectal cancer were referred in our observation and underwent MS-CTA between June 2020 and March 2022. We classified the distribution of LCA and confirmed whether there exists AMCA (accessory middle colic artery). Then we planned blood flow path based on the classification of LCA branches before operation. High ligation was applied in regular radical surgery. During operation, we carefully protect the bifurcation of ascending and descending LCA. Then we compared the planned blood flow path with the actual postoperative blood flow path to verify the mechanism we proposed previously. RESULTS Of 89 patients, 82 cases met our criteria, we summarized 6 distribution pattens of LCA ascending and descending branches. These preoperative pattens are consistent with the inspection during operation. The postoperative blood flow path of 6 pattens is evolved from the above adjacent anastomotic branches and is consistent with the planned blood flow path. We also found 2 cases with IMA stenosis and 1 case with SMA stenosis under pathological condition, and their compensatory blood flow path is in accordance with our theory. The rate of the anastomotic leakage in our study group is relatively low (7.3%). CONCLUSION MS-CTA could confirm the distribution of LCA and AMCA, display accurate postoperative blood reconstruction path after IMA high ligation, and it further verified the mechanism we proposed previously, which is the proximal anastomotic branches forming new blood flow path from high-pressure area to the low-pressure area. This mechanism might be helpful for performing accurate laparoscopic sigmoid and rectal cancer surgery.
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Affiliation(s)
- Ying Wang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Lei Wang
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Manfei Liang
- Medical Science and Technology Innovation Center, Shandong First Medical University, Jinan, Shandong, PR China
| | - Zhongkai Xu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Yiheng Xue
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China
| | - Guoqin Liu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, PR China.
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22
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Feng W, Miao Y, Li W, Xu Z, Chen F, Lv Z, Liu W, Zheng M, Zhao J, Zong Y, Lu A. High ligation versus low ligation of the inferior mesenteric artery in laparoscopic rectal cancer surgery: a retrospective study on surgical and long-term outcome. Langenbecks Arch Surg 2023; 408:249. [PMID: 37380790 DOI: 10.1007/s00423-023-02980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND In laparoscopic low anterior resection for rectal cancer surgery, there has been controversy to whether the inferior mesenteric artery (IMA) should be ligated at the origin of its aorta (high ligation (HL)) or below the branches of the left colonic artery (LCA) (low ligation (LL)). This study was intended to clarify oncological outcome and long-term prognosis of retrospective analysis. METHODS Analyzed the cases who underwent laparoscopic low anterior resection (LAR) in Shanghai Ruijin Hospital from January 2015 to December 2016, 357patients scheduled into 2 groups according to the level of IMA ligation: HL (n = 247) versus LL (n = 110). RESULTS The primary endpoint is long-term outcomes, and the secondary endpoint is the incidence rate of major postoperative complications. There were no significant differences in 5-year overall survival (P = 0.92) and 5-year disease-free survival (P = 0.41). There were no differences between the clinical baseline levels in each group. The incidence of low anterior resection syndrome (LARS) in the two groups was statistically significant (P = 0.037). No significant differences were observed in operative time (P = 0.092) and intraoperative blood loss (P = 0.118). In the HL group, 6 cases (2.4%) had additional colonic excision due to poor anastomotic blood supply; none of the colonic anastomosis in the low ligation group had ischemic manifestations, and length from the proximal margin (P = 0.076), length from the distal margin (P = 0.184), the total number of lymph nodes excised (P = 0.065), and anastomotic leakage incidence (P = 0.33). CONCLUSION Low ligation of the IMA which reserved LCA with vascular root lymph node dissection in laparoscopic low anterior resection for rectal cancer surgery may help protect the blood supply of the anastomosis, and will not increase postoperative complications while enhance recovery, without compromising radical excision and long-term prognosis.
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Affiliation(s)
- Wenqing Feng
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Yiming Miao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Wenchang Li
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Zifeng Xu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Fangqian Chen
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Zeping Lv
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Wangyi Liu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Minhua Zheng
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Jingkun Zhao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Yaping Zong
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China
| | - Aiguo Lu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, China.
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23
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Chang CT, Lim WX, Liu TT, Lin YM, Chang CD. Inferior mesenteric artery arteriovenous malformation, a rare cause of ischemic colitis: A case report. Medicine (Baltimore) 2023; 102:e33413. [PMID: 36961132 PMCID: PMC10036045 DOI: 10.1097/md.0000000000033413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels that connects the arteries and the veins. Because normal capillary bed is partially or completely absented in the AVM, the blood passes quickly from the arteries to the veins, which disrupts normal blood flow and oxygen supply to the surrounding tissues. This is called "steal phenomenon," and in the inferior mesenteric artery (IMA) territory, this may lead to abdominal pain, gastrointestinal bleeding, portal hypertension, and even ischemic colitis. PATIENT CONCERNS A 67-year-old man presented to our emergency department because of left side abdominal pain. DIAGNOSES The abdominal computed tomography with contrast enhancement revealed a cluster of abnormal vascular lesions abutting the IMA with early opacification of the left colonic marginal vein. In addition, poor enhancement of segmental colonic wall was found from proximal descending colon to middle rectum. The diagnosis of AVM of the IMA and ischemic colitis was made. INTERVENTIONS The patient underwent left hemicolectomy as well as the AVM resection. OUTCOMES He was discharged uneventfully after the surgery without complications. LESSONS IMA AVM carries the risk of ischemic colitis. computed tomography scan is helpful not only to the diagnosis of AVMs but also to exclude other lesions as well. Treatment options include endovascular embolization, surgical intervention, and a combination of both. Due to the complexity of this disease, treatment requires a case-specific multidisciplinary approach and a coordination of medical, radiological, and surgical staffs.
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Affiliation(s)
- Ching-Tang Chang
- Department of Emergency, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Xiong Lim
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ting-Ting Liu
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Ming Lin
- Department of Surgery, Division of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Di Chang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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24
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Väärämäki S, Viitala H, Laukontaus S, Uurto I, Björkman P, Tulamo R, Aho P, Laine M, Suominen V, Venermo M. Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 65:264-270. [PMID: 36334900 DOI: 10.1016/j.ejvs.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/05/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B). METHODS Patients were treated with EVAR in two centres during the period 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates. RESULTS Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively. CONCLUSION The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.
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Affiliation(s)
- Suvi Väärämäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland.
| | - Herman Viitala
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sani Laukontaus
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Uurto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Patrick Björkman
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Aho
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Laine
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sato A, Imaizumi K, Kasajima H, Ichimura K, Sato K, Yamana D, Tsuruga Y, Umehara M, Kurushima M, Nakanishi K. Short- and long-term outcomes of preservation versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis. Langenbecks Arch Surg 2023; 408:23. [PMID: 36637543 DOI: 10.1007/s00423-023-02771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/09/2022] [Indexed: 01/14/2023]
Abstract
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 IMA (PIMA) 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 PIMA (n = 41) at a single center between January 2005 and March 2022. After propensity score matching, 64 patients (LIMA, n = 32; PIMA, 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 the surgical outcomes, including 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 PIMA groups (3-year recurrence-free survival, 72.2% vs. 75.6%, P = 0.862; 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 PIMA 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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Affiliation(s)
- Aya Sato
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Ken Imaizumi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan.
| | - Hiroyuki Kasajima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Kentaro Ichimura
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Daisuke Yamana
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Yosuke Tsuruga
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Minoru Umehara
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Michihiro Kurushima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
| | - Kazuaki Nakanishi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatomachi, Hakodate, Hokkaido, 041-8680, Japan
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Nair M, Kingsmore D, Hennessy M, Hussey K. Stenting the Inferior Mesenteric Artery for Chronic Mesenteric Ischaemia. Eur J Vasc Endovasc Surg 2023; 65:159-160. [PMID: 36216235 DOI: 10.1016/j.ejvs.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/23/2022] [Accepted: 10/02/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Manoj Nair
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
| | - David Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin Hennessy
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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27
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Zhong W, Liu C, Zhang L, Zhong J, He X, Fang C, Liu H, Xia L, Zuo Z, Zhang L. Comparison of high or modified low tie of the inferior mesenteric artery in laparoscopic rectal cancer surgery: A meta-analysis. Medicine (Baltimore) 2022; 101:e32065. [PMID: 36451442 PMCID: PMC9704925 DOI: 10.1097/md.0000000000032065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to perform a meta-analysis comparing the oncological, intraoperative and safety outcomes in laparoscopic rectal cancer surgery with and without preservation of the left colic artery (LCA). METHOD We searched several databases including PubMed, Web of Science, Cochrane Library, and Embase databases. This meta-analysis included randomized clinical trials, prospective, and retrospective comparative studies regarding high- or modified low-tie ligation of the inferior mesenteric artery in laparoscopic rectal cancer surgery. RESULTS Of 641 potentially eligible articles, 16 studies with 3050 participants met the eligibility criteria and were included in the meta-analysis. There was no significant difference in estimated blood loss (WMD -2.63, 95% CI -5.69 to 0.43; P = .09), the number of harvested lymph nodes (WMD -0.35, 95% CI -1.60 to 0.20; P = .50), the number of apical lymph node yield (WMD -0.19, 95% CI -0.52 to 0.13; P = .24), the number of apical lymph node metastasis (OR 0.76, 95% CI 0.40 to 1.45; P = .40), rate of conversion to open surgery (OR 0.74, 95% CI 0.50 to 1.09; P = .513), rate of urinary dysfunction (OR 1.39, 95% CI 0.71 to 2.74; P = .34), rate of recurrence and metastasis (OR 1.10, 95% CI 0.75 to 1.61; P = .64), 5-year survival rate (OR 0.89, 95% CI 0.67 to 1.18; P = .42). However, this meta-analysis demonstrated a statistically significant difference in operating time (WMD -9.92, 95% CI -15.49 to -5.84; P = .0005), rate of diverting stom (OR 1.42, 95% CI 1.06 to 1.92; P = .02), rate of anastomotic leakage (OR 2.673, 95% CI 1.91 to 3.62; P < .00001), time to first flatus (WMD 0.29, 95% CI 0.11 to 0.48; P = .002), time of hospitalization (WMD 0.64, 95% CI 0.14 to 1.15; P = .01) between the 2 surgical techniques. COCLUSION The available evidence suggests that preserving the left colic artery is a safe, effective technique for patients with laparoscopic rectal cancer. nique for patients with laparoscopic rectal cancer.
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Affiliation(s)
- Wu Zhong
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Chuanyuan Liu
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Lei Zhang
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Junqiao Zhong
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Xianping He
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Chuanfa Fang
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Hongquan Liu
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Laiyang Xia
- Department of Gastroenterological Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Zhengyun Zuo
- Department of Anorectal Surgery, Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Leichang Zhang
- Department of Anorectal Surgery, Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
- *Correspondence: Leichang Zhang, Department of Anorectal Surgery, Hospital of Jiangxi University of Traditional Chinese Medicine, No. 445 Bayi Avenue, Nanchang 330006, Jiangxi, China (e-mail: )
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Chen J, Wang M, Chen Y, Chen S, Xiao J, Fan X, Yang J, He B. A clinical study of inferior mesenteric artery typing in laparoscopic radical resections with left colonic artery preservation of rectal cancer. World J Surg Oncol 2022; 20:292. [PMID: 36089588 PMCID: PMC9465900 DOI: 10.1186/s12957-022-02762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES An investigation of the effects of different types of the inferior mesenteric artery (IMA) on laparoscopic left colic artery (LCA) radical resection of rectal cancer was conducted. METHODS Clinical data were collected from 92 patients who underwent laparoscopic radical resection of rectal cancer with preservation of the LCA at Nantong University's Second Affiliated Hospital. All patients underwent full-abdominal dual-energy CT enhancement examination before surgery and 3D post-processing reconstruction of the IMA. Two radiologists with >3 years of experience in abdominal radiology jointly conducted the examination. A total of three types of IMA were identified among the patients: IMA type I (the LCA arising independently from the IMA), type II (LCA and sigmoid colon artery [SA] branching from a common trunk from IMA), and type III (LCA, SA, and superior rectal artery [SRA] branching from the IMA at the same point). The baseline data, pathological results, and intra-operative and post-operative indicators of the groups were analyzed. RESULTS The proportions of type I, type II, and type III IMA were 58.70% (54/92), 18.48% (17/92), and 22.82% (21/92), respectively. IMA typing was consistent with the preoperative CT evaluation results. The intra-operative blood loss of type III IMA patients [median (interquartile spacing), M (P25, P75): 52.00 (39.50, 68.50) ml] was higher than that of type I and II IMA patients [35.00 (24.00, 42.00) and 32.00 (25.50, 39.50) ml, respectively] (P<0.05). The incidence of anastomotic fistula in type III IMA patients (4 cases, 19.05%) was higher than that in non-type III IMA patients (1 case, 1.41%) (X2=6.679, P=0.010). The incidence of postoperative complications among the three types of IMA was not significantly different (P>0.05). CONCLUSIONS Among rectal cancer patients undergoing laparoscopic LCA preservation, type III IMA patients had more intraoperative bleeding and a higher incidence of postoperative anastomotic fistula. However, this did not increase the risk of overall postoperative complications.
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Affiliation(s)
- Jinghao Chen
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, 226006 Jiangsu Province China
| | - Meirong Wang
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
| | - Yuhao Chen
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
| | - Suying Chen
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, 226019 Jiangsu Province China
| | - Xiaole Fan
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
| | - Jushun Yang
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
| | - Bosheng He
- Department of Radiology, Affiliated Hospital 2 of Nantong University, No.6 Hai Er Xiang North Road, Nantong, 226001 Jiangsu Province China
- Nantong Key Laboratory of Intelligent Medicine Innovation and Transformation, Nantong, 226001 Jiangsu China
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Toh JWT, Ramaswami G, Nguyen KS, Collins GP, Solis E, Pathma-Nathan N, El-Khoury T, Kim SH. 3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection. Surg Radiol Anat 2022; 44:1165-1170. [PMID: 35870000 PMCID: PMC9378323 DOI: 10.1007/s00276-022-02992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Recent studies have described the finding of the Arc of Riolan (AoR) crossing the inferior mesenteric vein (IMV) seen during high ligation of IMV while performing minimally invasive colectomies. However, the AoR usually has a medial course, and this variant AoR anatomic course and the clinical importance of its preservation during splenic flexure takedown in anterior resection remains controversial.
Methods
After institutional approval (QA-5775), radiological identification of and mapping of the vessel horizontally crossing the IMV under the pancreas, when present, was performed at a single institution (Westmead Hospital, New South Wales, Australia). One hundred consecutive computed tomographic (CT) mesenteric angiograms conducted in 2018 were reviewed retrospectively to determine the presence of a vessel horizontally crossing the IMV. 3D reconstructions were used to map out its course to understand its origin and full course. Baseline characteristics, including demographic and comorbidity data, were obtained from the medical record.
Results
On 3D mesenteric angiogram reconstructions, a vessel crossing anterior to the IMV was present in 11 of 98 cases (11.2%). Two cases were excluded as the presence of this vessel was indeterminate. Eight of 11 patients (72.7%) were male, and the mean age was 49.3 years (range: 21–80 years). There was no statistically significant difference in age and comorbidities between the groups. Importantly, in all 11 cases, there was an arterial vessel crossing the IMV originating from the SMA and communicating with the IMA or a branch of the IMA, proving definitively that this vessel was by definition the AoR.
Conclusion
This 3D mesenteric angiogram mapping study has shown definitively that the vessel horizontally crossing anterior to the IMV and inferior to the pancreas is an arterial vessel from the SMA to IMA, and by definition the Arc of Riolan. When present, identification and preservation of this collateral arterial vessel during splenic flexure takedown in anterior resection may be important in reducing the risk of post-operative bowel ischaemia.
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Affiliation(s)
- James Wei Tatt Toh
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
- Colorectal Department, Westmead Hospital, Sydney, Australia.
- Colorectal Department, Division of Surgery and Anaesthetics, Westmead Hospital, Westmead, Cnr Hawkesbury and Darcy Rd, Sydney, 2145, Australia.
| | | | - Kim Son Nguyen
- Department of Radiology, Westmead Hospital, Sydney, Australia
| | - Geoffrey Peter Collins
- Colorectal Department, Westmead Hospital, Sydney, Australia
- The University of Notre Dame, Sydney, Australia
| | - Edgardo Solis
- Colorectal Department, Westmead Hospital, Sydney, Australia
| | - Nimalan Pathma-Nathan
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
- Colorectal Department, Westmead Hospital, Sydney, Australia
| | - Toufic El-Khoury
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
- Colorectal Department, Westmead Hospital, Sydney, Australia
- The University of Notre Dame, Sydney, Australia
| | - Seon Hahn Kim
- Colorectal Department, Korea University Anam Hospital, Seoul, South Korea
- Korea University College of Medicine, Seoul, South Korea
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Frandon J, Berny L, Prudhomme M, de Forges H, Serrand C, de Oliveira F, Beregi JP, Bertrand MM. Inferior mesenteric artery embolization ahead of rectal cancer surgery: AMIREMBOL pilot study. Br J Surg 2022; 109:650-652. [PMID: 35333313 PMCID: PMC10364674 DOI: 10.1093/bjs/znac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/22/2021] [Accepted: 02/19/2022] [Indexed: 08/02/2023]
Abstract
Ischaemic conditioning in rectal cancer surgery by preoperative embolization of the inferior mesenteric artery is feasible and safe. It seems to protect from ischaemic stress during the surgical procedure.
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Affiliation(s)
- Julien Frandon
- Correspondence to: Julien Frandon, CHU de Nîmes, Medical Imaging Group Nîmes, IMAGINE team, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France (e-mail: )
| | - Laure Berny
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes (IMAGINE), Nîmes, France
| | - Michel Prudhomme
- Surgery Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes (IMAGINE), Nîmes, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nîmes, Nîmes, France
| | - Fabien de Oliveira
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes (IMAGINE), Nîmes, France
| | - Jean Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes (IMAGINE), Nîmes, France
| | - Martin M Bertrand
- Surgery Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Zheng H, Li F, Xie X, Zhao S, Huang B, Tong W. Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis. BMC Surg 2022; 22:164. [PMID: 35538516 PMCID: PMC9092824 DOI: 10.1186/s12893-022-01614-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Preserving the left colic artery (LCA) during anterior resection for rectal cancer is controversial, and robust evidence of the outcomes of LCA preservation plus apical lymph node dissection is lacking. The purpose of this study was to investigate the impact of LCA preservation plus apical lymph node dissection surgery on anastomotic leakage and number of harvested lymph nodes. METHODS Patients who underwent laparoscopic or robotic anterior resection for rectal cancer between September 2017 and May 2020 were retrospectively assessed. The patients were categorized into two groups: preservation of LCA and nonpreservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was anastomotic leakage within 30 days after surgery. The secondary outcomes were number of harvested lymph nodes, 3-year overall survival, and 3-year disease-free survival. RESULTS A total of 216 patients were eligible for this study, and propensity score matching yielded 60 patients in each group. Anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA nonpreservation group (3.3% vs. 13.3%, P = 0.048). No significant differences were observed in blood loss, operation time, intraoperative complications, splenic flexure mobilization, total number of harvested lymph nodes, number of positive lymph nodes, time to first flatus, or postoperative hospital stay. Kaplan-Meier survival analysis showed a 3-year disease-free survival of 85.7% vs. 80.5% (P = 0.738) and overall survival of 92.4% vs. 93.7% (P = 0.323) for the preservation and nonpreservation groups, respectively. CONCLUSION LCA preservation plus apical lymph node dissection surgery for rectal cancer may help reduce the incidence of anastomotic leakage without impairing the number of harvested lymph nodes. Preliminary results suggest that 3-year disease-free survival and overall survival rates may not differ between the two types of surgery, but studies with larger sample sizes are needed to confirm these conclusions. Trial registration ClinicalTrials.gov, NCT03776370. Registered 14 December 2018-Retrospectively registered, https://clinicaltrials.gov .
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Affiliation(s)
- Huichao Zheng
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Xingjie Xie
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Song Zhao
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Bin Huang
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, 400042, China.
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Xiao Y. [Location of inferior mesentery artery ligation in rectal cancer surgery: how to make decisions based on available evidence]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:290-294. [PMID: 35461194 DOI: 10.3760/cma.j.cn441530-20220106-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There are still controversies as to the location of ligating the inferior mesenteric artery and the central lymph node dissection during rectal cancer surgery. The reason is that the level of evidence in this area is low. Existing studies are mostly retrospective, analyses or small-sample randomized controlled trials. These results showed no significant differences between high-ligation and low-ligation, in terms of anastomotic leakage and other short-term postoperative complications. Low-ligation seems better for the recovery of postoperative genitourinary function. Due to the low rate of central lymph node metastasis and many other confounding factors that affect the survival rate, it is difficult to conclude the survival benefits of ligation site or central node dissection. It is necessary to carry out some targeted, well-designed, large-scale randomized controlled trials to explain the related issues of inferior mesenteric artery ligation site and extent of central lymphadenectomy.
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Affiliation(s)
- Y Xiao
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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Wang ZQ. [Splenic flexure cancer: surgical procedures and extent of lymphadenectomy]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:300-304. [PMID: 35461196 DOI: 10.3760/cma.j.cn441530-20220112-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Splenic flexure colon cancer occurs at a relatively lower rate than colon cancer of other sites. It is also associated with more advanced disease and higher rate of acute obstruction. The splenic flexure receives blood supply from both superior and inferior mesenteric arteries (SMA and IMA), and therefore has lymphatic drainage to both areas. The blood supply is also highly variable, causing difficulties in determining the main feeding vessels and the main direction of lymph drainage. Few studies with limited cases focused on this specific tumor site with respect to the patterns of lymph node spread, especially the main lymph node status and the value of its dissection. The lack of information limits the development of a consensus on the extent of surgical resection and lymphadenectomy. Adequate mobilization of the colon facilitates a sufficient length of bowel resection and the high ligation of feeding arteries from both SMA and IMA. Further evidence on the chnoice of procedures and the extent of lymph node dissection need multicenter collaboration, with the use of modern techniques, including CT 3D reconstruction of the colon and angiography, as well as intraoperative fluorescent real-time imaging of lymph nodes.
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Affiliation(s)
- Z Q Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Tsarkov PV, Efetov SK, Zubayraeva AA, Puzakov KB, Oganyan NV. Surgeon's role in CT-based preoperative determination of inferior mesenteric artery anatomy in colorectal cancer treatment. Khirurgiia (Mosk) 2022:40-49. [PMID: 36073582 DOI: 10.17116/hirurgia202209140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The inferior mesenteric artery (IMA) is a blood vessel of great importance in left colon and rectal cancer surgery. We aimed to determine the role of surgeons in computed tomography (CT) based vascular anatomy interpretation. METHOD Patients with left colon and rectal cancer treated surgically with D3 lymph node dissection and selective vascular ligation were included in this study. All patients (n=250) underwent preoperative CT with intravenous contrast. The IMA anatomy was schematically depicted by surgeon based on CT interpretation. Intraoperatively anatomy was defined by skeletonisation of the IMA. All patients had segmental resection with selective vascular ligation. The concurrence of prospectively obtained results were evaluated by intraclass correlation and Kendall's tau-b test. Misinterpretation of IMA anatomy was analysed by CT-specialist. RESULTS The preoperative and intraoperative IMA anatomy features were correctly interpreted in 237 cases (in 94.8%) within skeletonisation extent, which is supported by high level of agreement and concordance of preoperative data regards to intraoperative findings (K=0.926; p<0.001; CC=0.912; p<0.001). As a result of the CT-based evaluation of the IMA, E, K, and H types of branching patterns were proposed. IMV position was mistakenly identified in 2.6% of cases. CONCLUSION Surgeons are able to evaluate the IMA anatomy accurately with CT and use it in routine preoperative planning. The E, K, and H branching types may be used when defining approach to skeletonisation and level of vascular ligation.
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Affiliation(s)
- P V Tsarkov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - S K Efetov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Zubayraeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K B Puzakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N V Oganyan
- Sechenov First Moscow State Medical University, Moscow, Russia
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Hamaguchi K, Hashimoto A, Owa H, Hattori A, Tanaka T, Kurebayashi M, Tahara Y, Fuke H, Shimizu A, Kondou A. [A case of ischemic proctitis caused by impaired venous blood flow 11 months after surgery for sigmoid colon cancer]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:236-244. [PMID: 35264487 DOI: 10.11405/nisshoshi.119.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A Japanese male in his 50s was presented to our hospital with the chief complaint of positive fecal immunochemical test. He had a history of hypertension. He underwent colonoscopy and was diagnosed with sigmoid colon cancer. He also underwent laparoscopic sigmoid colectomy with D3 lymph node dissection for sigmoid colon cancer. The inferior mesenteric artery and inferior mesenteric vein were amputated at the root of the vessels. The patient received adjuvant chemotherapy and was recurrence-free. Eleven months after the surgery, lower abdominal pain during defecation appeared. Contrast-enhanced computed tomography (CT) and colonoscopy showed marked rectal mucosal edema and increased fatty tissue density (dirty fat sign) around the anorectal side of the anastomosis. Intestinal blood flow was maintained. There were many fine blood vessels around the rectal wall, and the amputated distal part of the superior rectal artery was retrogradely contrasted. Amputated superior rectal artery and superior rectal vein were dilated than before. Colonoscopy revealed mucosal redness, edema, and easy bleeding on the anorectal side of the anastomosis. Abdominal contrast-enhanced 3D-CT showed increased arterial blood flow and increased fine blood vessels around the rectal wall. It suggested the presence of an arteriovenous fistula and venous congestion. Conservative treatment with total parenteral nutrition and prednisolone infusion did not improve the patient's condition, and a colostomy was performed. After colostomy, the pain improved, and the CT scan of the abdomen showed improvement in arterial blood flow and venous congestion. Colostomy was closed after 10 months. There has been no relapse since the closure of the colostomy. There are few reports on ischemic proctitis on the anorectal side of the anastomosis after colon cancer resection due to impaired venous blood flow.
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Affiliation(s)
- Koudai Hamaguchi
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Akira Hashimoto
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Hirono Owa
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Aiji Hattori
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Takamitsu Tanaka
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Marie Kurebayashi
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Yuichi Tahara
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Hiroyuki Fuke
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Atsuya Shimizu
- Department of Internal Medicine, Saiseikai Matsusaka General Hospital
| | - Akinobu Kondou
- Department of Surgery, Saiseikai Matsusaka General Hospital
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Kim HJ, Choi GS. Single-Port Robotic Low Anterior Resection With Lateral Pelvic Node Dissection in Locally Advanced Rectal Cancer. Dis Colon Rectum 2021; 64:e718. [PMID: 34561344 DOI: 10.1097/dcr.0000000000002170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Suwa Y, Watanabe J, Ozawa M, Ishibe A, Suwa H, Ota M, Kunisaki C, Endo I. Direct Approach to the Superior Mesenteric Artery for Dissection of the Proximal Lymph Nodes in Patients With Splenic Flexure Colon Cancer With an Accessory Middle Colic Artery. Dis Colon Rectum 2021; 64:e583. [PMID: 34001708 DOI: 10.1097/dcr.0000000000002042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yusuke Suwa
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Watanabe
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mayumi Ozawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hirokazu Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Yokohama Red Cross Hospital, Yokohama, Japan
| | - Chikara Kunisaki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Turgeon MK, Gamboa AC, Regenbogen SE, Holder-Murray J, Abdel-Misih SR, Hawkins AT, Silviera ML, Maithel SK, Balch GC. A US Rectal Cancer Consortium Study of Inferior Mesenteric Artery Versus Superior Rectal Artery Ligation: How High Do We Need to Go? Dis Colon Rectum 2021; 64:1198-1211. [PMID: 34192711 PMCID: PMC8573719 DOI: 10.1097/dcr.0000000000002052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The optimal level of pedicle ligation during proctectomy for rectal cancer, either at the origin of the inferior mesenteric artery or the superior rectal artery, is still debated. OBJECTIVE The objective was to determine whether superior rectal artery ligation portends equivalent technical or oncologic outcomes. DESIGN This was a retrospective analysis of a rectal cancer database (2007-2017). SETTINGS The study was conducted at 6 tertiary referral centers in the United States (Emory University, University of Michigan, University of Pittsburgh Medical Center, The Ohio State University Wexner Medical Center, Vanderbilt University Medical Center, and Washington University School of Medicine in St. Louis). PATIENTS Patients with primary, nonmetastatic rectal cancer who underwent low anterior resection or abdominoperineal resection were included. MAIN OUTCOME MEASURES Anastomotic leak, lymph node harvest, locoregional recurrence-free survival, recurrence-free survival, and overall survival were measured. RESULTS Of 877 patients, 86% (n = 755) received an inferior mesenteric artery ligation, whereas 14% (n = 122) received a superior rectal artery ligation. A total of 12%, 33%, 24%, and 31% were pathologic stage 0, I, II, and III. Median follow-up was 31 months. Superior rectal artery ligation was associated with a similar anastomotic leak rate compared with inferior mesenteric artery ligation (9% vs 8%; p = 1.0). The median number of lymph nodes removed was identical (15 vs 15; p = 0.38). On multivariable analysis accounting for relevant clinicopathologic factors, superior rectal artery ligation was not associated with increased anastomotic leak rate, worse lymph node harvest, or worse locoregional recurrence-free survival, recurrence-free survival, or overall survival (all p values >0.1). LIMITATIONS This was a retrospective design. CONCLUSIONS Compared with inferior mesenteric artery ligation, superior rectal artery ligation is not associated with either worse technical or oncologic outcomes. Given the potential risks of inadequate blood flow to the proximal limb of the anastomosis and autonomic nerve injury, we advocate for increased use of superior rectal artery ligation. See Video Abstract at http://links.lww.com/DCR/B646. ESTUDIO DEL CONSORCIO DE CNCER DE RECTO DE ESTADOS UNIDOS DE LIGADURA BAJA DE LA ARTERIA MESENTRICA INFERIOR CONTRA LIGADURA ALTA DE LA ARTERIA MESENTRICA INFERIOR QU TAN ALTO DEBEMOS EXTENDERNOS ANTECEDENTES:el nivel óptimo de la ligadura del pedículo en la proctectomía para el cáncer de recto, ya sea en el origen de la arteria mesentérica inferior o en la arteria rectal superior aún no esta definido.OBJETIVO:El objetivo era determinar si la ligadura de la arteria rectal superior pronostica resultados técnicos u oncológicos similares.DISEÑO:Análisis retrospectivo de una base de datos de cáncer de recto (2007-2017).ESCENARIO:el estudio se realizó en seis centros de referencia de tercer nivel en los Estados Unidos (Universidad de Emory, Universidad de Michigan, Centro médico de la Universidad de Pittsburgh, Centro médico Wexner de la Universidad Estatal de Ohio, Centro médico de la Universidad de Vanderbilt y Escuela de Medicina de la Universidad de Washington en St. Louis).PACIENTES:Se incluyeron pacientes con cáncer de recto primario no metastásico que se sometieron a resección anterior baja o resección abdominoperineal.PRINCIPALES VARIABLES ANALIZADAS:Se midió la fuga anastomótica, los ganglios linfáticos recuperados, la sobrevida sin recidiva locorregional, la sobrevida sin recidiva y la sobrevida global.RESULTADOS:De 877 pacientes, en el 86% (n = 755) se realizó una ligadura de la arteria mesentérica inferior, y en el 14% (n = 122) se realizó una ligadura de la arteria rectal superior. El 12%, 33%, 24% y 31% estaban en estadio patológico 0, I, II y III respectivamente. La mediana de seguimiento fue de 31 meses. La ligadura de la arteria rectal superior se asoció con una tasa de fuga anastomótica similar a la ligadura de la arteria mesentérica inferior (9 vs 8%, p = 1,0). La mediana del número de ganglios linfáticos extirpados fue idéntica (15 contra 15, p = 0,38). En el análisis multivariado que tiene en cuenta los factores clínico-patológicos relevantes, la ligadura de la arteria rectal superior no se asoció con una mayor tasa de fuga anastomótica, una peor cosecha de ganglios linfáticos o una peor sobrevida libre de recurrencia locorregional, sobrevida libre de recurrencia o sobrevida global (todos p> 0,1).LIMITACIONES:Diseño retrospectivo.CONCLUSIONES:En comparación con la ligadura de la arteria mesentérica inferior, la ligadura de la arteria rectal superior no se asocia a peores resultados técnicos ni oncológicos. Debido a los riesgos potenciales de un flujo sanguíneo inadecuado del muñon proximal de la anastomosis y la lesión de los nervios autonómicos, proponemos una mayor realización de la ligadura de la arteria rectal superior. Consulte Video Resumen en http://links.lww.com/DCR/B646.
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Affiliation(s)
- Michael K. Turgeon
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Adriana C. Gamboa
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Scott E. Regenbogen
- Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Holder-Murray
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sherif R.Z. Abdel-Misih
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander T. Hawkins
- Section of Colon and Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew L. Silviera
- Section of Colon & Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Shishir K. Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Glen C. Balch
- Division of Colon and Rectal Surgery, Department of Surgery, Emory University, Atlanta, Georgia
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Affiliation(s)
- Albert A Kota
- Department of Surgery, Christian Medical College, Vellore, India
| | - Keisin Wang
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Katherine Leckie
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Justin King
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - John Maijub
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
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Narushima K, Hirano A, Mori M, Yoshida M, Ohira G, Miyauchi H, Matsubara H, Shuto K. [Investigation for Arc of Riolan-Conserving High Ligation Using Simulation CT Colonography in Preoperative Colorectal Cancer]. Gan To Kagaku Ryoho 2021; 48:428-430. [PMID: 33790177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Simulation computed tomography colonography(sCTC), which combines CTC and 3-dimensional vascular imaging, is popular for the surgery of colorectal cancer. We experience anomaly, called arc of Riolan(aR), rarely but its definition and details are unclear. Using sCTC, we identified aR and investigated the simulation of aR-conserving high ligation. PATIENT AND METHOD The patients were 3 cases of sigmoid colorectal cancer with aR in 369 patients who underwent sCTC before colorectal cancer surgery. We identified the running morphology of aR. And we classified Griffiths' point as presence(P)and absence(A). Narrow or mesh-shaped artery which were ischemic risk factors of intestinal tract was P groups and normal artery was A groups in the marginal artery of splenic flexure. We simulated aR-conserving lymph node dissection using sCTC. RESULT Case 1. The patient was 60-year-old man with rectal cancer, cT4aN1M0, Stage Ⅲa. The running morphology of aR was between the left branch of middle colic artery(MCA lt)and LCA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N1M0, Stage Ⅲa. Case 2. The patient was 65-year-old woman with sigmoid colon cancer, cT3N2M0, Stage Ⅲb. The running morphology of aR was between MCA lt and IMA. Griffiths point: P. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT3N2M0, Stage Ⅲb. Case 3. The patient was 75-year-old woman with sigmoid colon cancer, cT1bN0M0, Stage Ⅰ. The running morphology of aR was between first jejunal artery and IMA. Griffiths point: A. Surgical simulation was D3 lymph node dissection with preservation of aR and high ligation of IMA. Pathological findings was pT1bN0M0, Stage Ⅲb. CONCLUSION Using sCTC, we could identify the various running morphology of aR and simulate aR-conserving lymph node dissection in high ligation.
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Affiliation(s)
- Kazuo Narushima
- Dept. of Surgery, International University of Health and Welfare Ichikawa Hospital
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GÖMCELİ İ, ARAS O. Clinical and oncological outcomes of the low ligation of the inferior mesenteric artery with robotic surgery in patients with rectal cancer following neoadjuvant chemoradiotherapy. Turk J Med Sci 2021; 51:111-123. [PMID: 32777903 PMCID: PMC7991877 DOI: 10.3906/sag-2003-178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background/aim The aim of this study is to compare clinical and oncologic outcomes of the high and low ligation techniques of the inferior mesenteric artery (IMA) in rectal cancer patients treated with robotic surgery after neoadjuvant chemoradiotherapy (nCRT). Materials and methods In this retrospective study, 77 patients with T3/T4-node negative rectal cancer with tumor penetration through the muscle wall (Stage 2) or node positive disease without distant metastases (Stage 3) who were treated electively with robotic surgical resection following nCRT at a single institution between January 2014 and January 2018 were analyzed. Patients were divided into 2 groups (38 patients were included in the low ligation group and 39 patients in the high ligation group). Results There was no statistical difference between the high ligation group and low ligation group in univariate analysis for 2-year overall survival and disease-free survival (OR = 1.146; 95% CI = 0.274 to 4.797; P = 0.950, and OR = 1.141; 95% CI = 0.564 to 2.308; P = 0.713, respectively). There was no significant difference between the 2 groups in the mean number of harvested lymph nodes and mean number of metastatic lymph nodes (P = 0.980 and P = 0.124, respectively). Anastomosis stricture was observed significantly less frequently in the low ligation group versus the high ligation group (2.6% and 28.2%, respectively) (P = 0.002). Also, the difference for the median length of hospital stay for the high and low ligation groups was statistically significant in favor of the low ligation group (P = 0.011). Conclusion In robotic rectal surgery, the low ligation technique of the IMA can reduce the rate of anastomosis stricture and provide similar oncological results as the high ligation technique.
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Affiliation(s)
- İsmail GÖMCELİ
- Department of Gastrointestinal Surgery, Antalya Training and Research Hospital, Health Sciences University, AntalyaTurkey
| | - Orhan ARAS
- Department of Gastrointestinal Surgery, Antalya Training and Research Hospital, Health Sciences University, AntalyaTurkey
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Suffat LP, Petrelli LC, Mondini G, Lettini I, Bono L, Marsengo R, Bergantino A, Rosato L. Ideal level of ligation of the inferior mesenteric artery. An old debate for a current surgical approach. Ann Ital Chir 2021; 92:549-553. [PMID: 34795106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The ideal level of ligation of the inferior mesenteric artery (IMA) during resection for colorectal cancer is still controversial. The aim of this study was to demonstrate the real advantages and, above all, the adequacy of oncological staging after a low ligation of the IMA with additional LN retrieval in patients undergoing surgery for colorectal cancer. MATERIALS AND METHODS Between January 2013 and December 2020, 157 patients who underwent curative resection of a primary colorectal tumor were retrospectively included: 64 patients underwent high ligation of the IMA and 93 patients underwent low ligation of the IMA with additional LN retrieval. Results - Mean number of lymphnodes harvested (the median number of harvested nodes was 16.2 in "high ligation" group vs 15.4 in "low ligation" group), operation time (272 minutes vs 293 minutes), intraoperative blood loss (40 cc vs 53 cc) and recovery time (median postoperative hospitalization was 6.4 days in both groups) were not significantly different between the groups. DISCUSSION High ligation of the IMA preserves an adequate length of the colon to perform a successful anastomosis and facilitates apical LN dissection. However, it may be associated with an increased risk of anastomotic leakage. Low ligation of the IMA is less invasive and it is associated with a better preservation of genitourinary function and, futhermore, with an accurate oncological clearance. CONCLUSION Low ligation of the IMA with additional LN retrieval might be an oncologically safe and less invasive procedure in the surgical management of patients with colorectal cancer. KEY WORDS Colorectal cancer, Inferior mesenteric artery, Ligation.
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Zhang C, Li A, Luo T, Li Y, Li F, Li J. Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography. World J Gastroenterol 2020; 26:3484-3494. [PMID: 32655271 PMCID: PMC7327791 DOI: 10.3748/wjg.v26.i24.3484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Handling of the inferior mesenteric artery (IMA) and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer. However, the branching of this artery and the drainage patterns of this vein vary among individuals, and the characteristics and perfusion region of this artery in elderly patients remain unclear.
AIM To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.
METHODS We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography. Collateral arterial arches and the IMA hemoperfusion region were also recorded. Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.
RESULTS Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. The collateral circulation existed in the colonic perfusion region, including the marginal artery (Drummond’s artery), the ascending branch of the left colonic artery to supply the transverse colon, and the arc of Riolan with a frequency of 100%, 22.7%, and 1.9%, respectively. The IMA perfusion region was independently associated with the comorbidity of atherosclerosis, IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.
CONCLUSION The IMA and its branches are prone to arteriosclerosis, and IMA perfusion may be interrupted at the splenic flexure in elderly patients. The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Yu Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
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Munechika T, Kajitani R, Matsumoto Y, Nagano H, Komono A, Aisu N, Morimoto M, Yoshimatsu G, Yoshida Y, Hasegawa S. 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. Surg Endosc 2020; 35:1696-1702. [PMID: 32297053 DOI: 10.1007/s00464-020-07556-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Complete mesocolic excision with central vascular ligation is a standard advanced technique for achieving favorable long-term oncological outcomes in colon cancer surgery. Clinical evidence abounds demonstrating the safety of high ligation of the inferior mesenteric artery (IMA) for sigmoid colon cancer but is scarce for descending colon cancer. A major concern is the blood supply to the remnant distal sigmoid colon, especially for cases with a long sigmoid colon. We sought to clarify the safety and feasibility of high ligation of the IMA in surgery for descending colon cancer using indocyanine green (ICG) fluorescence imaging. METHODS In this prospective single-center pilot study, we examined 20 patients with descending colon cancer who underwent laparoscopic colectomy between April 2018 and September 2019. Following full mobilization and division of the proximal colonic mesentery, we temporarily clamped the root of the IMA and performed ICG fluorescence imaging of the blood flow to the sigmoid colon. The postoperative anastomosis-related complications (primary endpoint) and length of viable remnant colon, and the number of lymph nodes retrieved (secondary endpoints) were evaluated and compared with historical controls who underwent conventional IMA-preserving surgery (n = 20). RESULTS Blood flow reached 40 (17-66) cm retrograde from the peritoneal reflection, even after IMA clamping. Accordingly, IMA high ligation was performed in all cases. No anastomotic anastomosis-related complications occurred in each group. Retrieved total lymph nodes were higher in number in the ICG-guided group than in the conventional group (p = 0.035). Specifically, more principal nodes were retrieved in the ICG-guided group, compared with the conventional group (p = 0.023). However, the distal margin was not as long compared with the conventional group. CONCLUSION We demonstrated the safety and feasibility of high ligation of the IMA for descending colon cancer without sacrificing additional distal colon using fluorescence evaluation of blood flow in the remnant colon.
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Affiliation(s)
- Taro Munechika
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Komono
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mitsuaki Morimoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Gumpei Yoshimatsu
- Department of Regenerative and Transplant Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
- Department of Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.
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You X, Liu Q, Wu J, Wang Y, Huang C, cao G, Dai J, Chen D, Zhou Y. High versus low ligation of inferior mesenteric artery during laparoscopic radical resection of rectal cancer: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e19437. [PMID: 32195939 PMCID: PMC7220455 DOI: 10.1097/md.0000000000019437] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic radical resection is standard treatment for resectable rectal cancer. However, whether high or low inferior mesenteric artery (IMA) ligation should be performed remains controversial. This retrospective cohort study compared the advantages and disadvantages of low vs high IMA ligation in patients undergoing laparoscopic total mesorectal excision for rectal cancer.Rectal cancer patients (n = 322) undergoing total mesorectal excision at our institution in 2010 to 17 were enrolled; 174 underwent high IMA ligation group and 148 low IMA ligation (LIMAL group). Baseline data on patients, operative indices, economic indices, pathology findings, perioperative complications, and survival in the 2 groups were analyzed retrospectively.The low IMA ligation group had significantly higher anus retention ratio (P = .022), shorter hospital stay (P = .025), lower medical expenses (P = .032), fewer cases of anastomotic leakage (P = .023) and anastomotic stricture (P < .001), and lower incidence of postoperative genitourinary dysfunction (P = .003). Cox regression analysis indicated that local recurrence, distant metastasis, tumor differentiation, and tumor-node-metastasis stage were independently associated with survival.Low ligation of the IMA during laparoscopic radical resection of rectal cancer appears to be associated with a lower risks for anastomotic leakage, anastomotic stricture, and genitourinary dysfunction, a shorter hospital stay, and lower costs. In contrast, the rate of lymph node harvest, tumor recurrence rate, metastasis, or mortality was not found to be related with the level of IMA ligation.
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Jolivet M, Trilling B, Sage PY, Boussat B, Girard E, Faucheron JL. Prospective evaluation of functional outcomes after laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease in consecutive male patients. Tech Coloproctol 2019; 24:33-40. [PMID: 31820191 DOI: 10.1007/s10151-019-02123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, there has been no consensus concerning the vascular approach during sigmoid colectomy for diverticular disease. The aim of this study was to determine the functional impact of elective laparoscopic sigmoidectomy performed with high ligation of the inferior mesenteric artery for diverticulitis in consecutive male patients. METHODS Twenty-five consecutive patients of median age 53 years were enrolled in a prospective single-centre pilot study at a tertiary teaching hospital. Main outcome measures were functional results. Patients were asked to complete standardized, validated questionnaires to evaluate preoperative and 6 months postoperative bowel symptomatology (Jorge-Wexner Incontinence Score and KESS score), urinary function (IPSS), and sexual function (IIEF). Secondary outcomes were surgical data, morbidity, and quality of life (SF-36). RESULTS There were no significant differences between preoperative and 6 months postoperative total scores for bowel symptomatology, urinary function, and sexual function. There were no perioperative deaths. The morbidity rate was 12% including three minor and no major events. Quality of life demonstrated statistically better general health (p < 0.01) and better medical status over the prior 4 weeks at 6 months after surgery, compared to baseline. This single-centre prospective study has a limited number of patients, relatively short follow-up time, and includes only male patients. CONCLUSION Laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease does not induce functional disorders at 6 months after surgery. The benefit of the operation for quality of life is even greater for general health and medical status.
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Affiliation(s)
- M Jolivet
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - B Trilling
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - P-Y Sage
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - B Boussat
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
- Quality of Care Unit, Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - E Girard
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - J-L Faucheron
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France.
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France.
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Liu X, Zhang J, Chen H, Zhang L, Wang H, Ji M, Wang J, Zhu E, Wang J, Tian M. Riolan arch pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm: A case report. Medicine (Baltimore) 2019; 98:e17789. [PMID: 31770196 PMCID: PMC6890315 DOI: 10.1097/md.0000000000017789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Riolan arch thickening is usually caused by the occlusion of the superior mesenteric artery (SMA), inferior mesenteric artery, or abdominal aortic artery, by colon cancer, or by ulcerative colitis in the active phase. PATIENT CONCERNS A 61-years-old female was admitted due to left lower abdominal pain, nausea, and vomiting for more than 4 days. She had received an endovascular covered stent-graft exclusion due to abdominal aortic aneurysm 18 months earlier. Computed tomographic angiography (CTA) showed a local rupture of 1 of the branch artery of the SMA, and a pseudoaneurysm was formed around it. It was feared that performing Riolan atrial arch pseudoaneurysm embolization may cause ischemia of the inferior mesenteric artery (IMA) and could lead to avascular necrosis of the descending colon and sigmoid colon, intestinal perforation, and peritonitis. DIAGNOSIS Riolan arch collateral circulation associated with pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm. INTERVENTIONS Riolan arterial arch pseudoaneurysm embolization was performed near the distal end. OUTCOMES The symptoms, signs, and biochemistry returned to normal. CONCLUSION Riolan arch collateral circulation can be caused by pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm.
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Affiliation(s)
| | | | | | | | - Hongtao Wang
- Department of Anesthesiology, Yan’an Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Min Ji
- Department of Vascular Intervention
| | | | | | - Jiaping Wang
- Department of Intervention, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Tian
- Department of Vascular Intervention
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Parikh RS, Neuwirth C, Barzana DC, Williams ZF. Fibromuscular Dysplasia Causing High-Grade Stenosis of Mesenteric Vessels Requiring Reimplantation of Inferior Mesenteric Artery. Am Surg 2019; 85:e214-e215. [PMID: 31043218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Yang X, Ma P, Zhang X, Wei M, He Y, Gu C, Deng X, Wang Z. Preservation versus non-preservation of left colic artery in colorectal cancer surgery: An updated systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e13720. [PMID: 30702552 PMCID: PMC6380791 DOI: 10.1097/md.0000000000013720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It remains unclear whether or not preservation of the left colic artery (LCA) for colorectal cancer surgery. The objective of this updated systematic review and meta-analysis is to evaluate the current scientific evidence of LCA non-preservation versus LCA preservation in colorectal cancer surgery. METHODS A systematic search was conducted in the Medline, Embase, PubMed, Cochrane Library, ClinicalTrials, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature Database, and reference without limits. Quality of studies was evaluated by using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for assessing the risk of bias. Effective sizes were pooled under a random- or fixed-effects model. The funnel plot was used to assess the publication bias. The outcomes of interest were oncologic consideration including the number of apical lymph nodes, overall recurrence, 5-years overall survival, and 5-years disease-free survival (DFS); safety consideration including overall 30-day postoperative morbidity and overall 30-day postoperative mortality; anatomic consideration including anastomotic circulation, anastomotic leakage, urogenital, and defaecatory dysfunction. RESULTS Twenty-four studies including 4 randomized controlled trials (RCTs) and 20 cohort studies with a total of 8456 patients (4058 patients underwent LCA non-preservation surgery vs 4398 patients underwent LCA preservation surgery) were enrolled in this meta-analysis. The preservation of LCA was associated with significantly less anastomotic leakage (odds ratio 1.23, 95% confidence interval 1.02-1.48, P = .03). In term of sexual dysfunction, urinary retention, the number of apical lymph nodes, and long-term oncologic outcomes, there were no significant differences between the LCA non-preservation and LCA preservation group. It was hard to draw definitive conclusions on other outcomes including operation time, blood loss, the first postoperative exhaust time, and perioperative morbidity and mortality for insufficient data and highly significant heterogeneity among studies. CONCLUSIONS The pooled data provided evidence to support the LCA preservation preferred over LCA non-preservation in anastomotic leakage. Future more large-volume, well-designed RCTs with extensive follow-up are needed to draw a definitive conclusion on this dilemma.
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Affiliation(s)
- Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Pingfan Ma
- State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University,Chengdu, China
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Yazhou He
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
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Otani Y, Okabayashi T, Shibuya Y, Sumiyoshi T, Sui K, Iwata J, Morita S, Shimada Y. A Surgical Case of Inferior Mesenteric Arteriovenous Malformation. Surg Technol Int 2018; 33:101-104. [PMID: 30276782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The treatment option for inferior mesenteric arteriovenous malformations is under debate because of the number of cases. We, herein, report about a 35-year-old man with congenital inferior mesenteric artery malformation (AVM) presenting with mucous stool and severe abdominal pain. The radical operation, after building the diverting stoma, minimized the extent of the resection. This is the first reported case where surgical management was used to control severe symptoms induced by inferior mesenteric AVM.
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Affiliation(s)
- Yusuke Otani
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yuichi Shibuya
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Tatsuaki Sumiyoshi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan
| | - Sojiro Morita
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Yasuhiro Shimada
- Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
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