Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Son, Gyung Mo; Kim, Tae Un; Park, Byung-Soo; Jung, Hyuk; Lee, Sang Su; Yoon, Ji-Uk; Lee, Jun Woo

doi:10.4174/astr.2019.97.2.74

Cited by 13 publications

(13 citation statements)

References 30 publications

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“…The HT is credited for ease of lymph node dissection (LND) around IMA for staging and oncological outcome plus tension-free anastomosis of the remaining colon. 3 , 4 The compromise of blood supply leading to colon ischemia, 5 hypoperfusion and anastomotic leakage (AL), 6 , 7 damage to superior hypogastric plexus, 8 and genitourinary defecatory functions 9 are some concerns for the HT. The LT has shown a decrease in leakage with the comparable oncological outcome and 5-year long-term survival.…”

Section: Introductionmentioning

confidence: 99%

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Luo¹,

Yu²,

Huang³

et al. 2021

CMAR

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Background: Preservation of the left colic artery in low-tie (LT) of inferior mesenteric artery remains controversial compared to high-tie (HT) in the colon and rectal cancers, for lymph node dissection, anastomotic leakage, and oncological outcome. This cohort study aims to analyze short-and long-term outcomes of laparoscopic anterior resections in LT vs HT for rectal cancers. Methods: We analyzed a cohort of laparoscopic AR for RC from 2013 to 2016 at Renji Hospital, Shanghai, China. Short-and long-term outcome in LT vs HT group were compared for clinico-demographic characteristics, operative-time, lymph node dissection, short-term 30day outcome, and long-term 3-and 5-year overall survival as well as disease-free survival. The x 2 , t-test, and logistic regressions analysis were used and p<0.05 was considered significant. Results: The cohort consisted of 614 laparoscopic AR with LT (236) and HT (378). The clinicodemographic characteristics were comparable among the groups. The surgery took longer in LT. The yield of LND was similar. Leakage occurred in 12.21% (n=75). Leakage was fewer in LT than HT, 8.89% vs 14.28%, p=0.047. The postoperative severe complications were higher in HT. The 30-day mortality was nil. The long-term 3-and 5-year overall survival and disease-free survival were similar in LT and HT. Conclusion:The LT with preservation of left colic artery had similar lymph node yield, but lower leakage and complications than HT in laparoscopic anterior resections for rectal cancers. The long-term 3-and 5-year overall and disease-free survival were similar in the two groups.

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Section: Introductionmentioning

confidence: 99%

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Luo¹,

Yu²,

Huang³

et al. 2021

CMAR

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“…One of reasons for anastomotic complications is able to explain with poor perfusion in the anastomosis site[ 1 - 5 ]. It is known that about 10% of the population has poorly developed collateral circulation branches around the splenic flexure of the colon[ 6 - 9 ]. Due to the differences in vascular structure, the resection and anastomosis in the poorly perfused colonic area may lead to postoperative colonic hypoperfusion[ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery

Park

Baek

et al. 2020

WJG

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BACKGROUND Colonic perfusion status can be assessed easily by indocyanine green (ICG) angiography to predict ischemia related anastomotic complications during laparoscopic colorectal surgery. Recently, various parameter-based perfusion analysis have been studied for quantitative evaluation, but the analysis results differ depending on the use of quantitative parameters due to differences in vascular anatomical structure. Therefore, it can help improve the accuracy and consistency by artificial intelligence (AI) based real-time analysis microperfusion (AIRAM). AIM To evaluate the feasibility of AIRAM to predict the risk of anastomotic complication in the patient with laparoscopic colorectal cancer surgery. METHODS The ICG curve was extracted from the region of interest (ROI) set in the ICG fluorescence video of the laparoscopic colorectal surgery. Pre-processing was performed to reduce AI performance degradation caused by external environment such as background, light source reflection, and camera shaking using MATLAB 2019 on an I7-8700k Intel central processing unit (CPU) PC. AI learning and evaluation were performed by dividing into a training patient group ( n = 50) and a test patient group ( n = 15). Training ICG curve data sets were classified and machine learned into 25 ICG curve patterns using a self-organizing map (SOM) network. The predictive reliability of anastomotic complications in a trained SOM network is verified using test set. RESULTS AI-based risk and the conventional quantitative parameters including T 1/2 max , time ratio (TR), and rising slope (RS) were consistent when colonic perfusion was favorable as steep increasing ICG curve pattern. When the ICG graph pattern showed stepped rise, the accuracy of conventional quantitative parameters decreased, but the AI-based classification maintained accuracy consistently. The receiver operating characteristic curves for conventional parameters and AI-based classification were comparable for predicting the anastomotic complication risks. Statistical performance verifications were improved in the AI-based analysis. AI analysis was evaluated as the most accurate parameter to predict the risk of anastomotic complications. The F1 score of the AI-based method increased by 31% for T 1/2 max , 8% for TR, and 8% for RS. The processing time of AIRAM was measured as 48.03 s, which was suitable for real-time processing. CONCLUSION In conclusion, AI-based real-time microcirculation analysis had more accurate and consistent performance than the conventional parameter-based method.

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“…The preservation of LCA during anterior resection for rectal cancer requires exposing IMA and LCA, which if of technical difficulties. Thus, preoperative evaluation of the IMA type based on three-dimensional CT reconstruction results is beneficial [15,37]. In this study, the IMA of 108 patients was divided into four types according to the three-dimensional CT reconstruction image.…”

Section: Discussionmentioning

confidence: 99%

“…Sorelius et al reported that high ligation of IMA disrupted LCA blood supply, resulting in decreased mesenteric blood supply and increased risk of colonic necrosis after rectal cancer surgery [14]. It has been suggested that atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery [15]. In other words, mesenteric hypoperfusion is more likely to occur in patients with short IMA length or high risk of atherosclerosis after IMA ligation during laparoscopic rectosigmoid surgery.…”

Section: Introductionmentioning

confidence: 99%

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Zheng

Tian

et al. 2020

Preprint

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Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

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Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

Cited by 13 publications

References 30 publications

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

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