Flush aortic tie <i>versus</i> selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma

Corder, A. P.; Karanjia, N D; Williams, John D.; Heald, R. J.

doi:10.1002/bjs.1800790730

Cited by 83 publications

(51 citation statements)

References 6 publications

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“…Ligation distal to the first branch of the inferior mesenteric artery ensures a viable blood supply to the bowel from which the stoma will be created. Corder et al studied 143 consecutive patients but failed to show any association between the method of vascular ligation and the risk of tumor recurrence and death [6]. Furthermore, anastomotic leak rates were not related to the method of vascular ligation.…”

Section: Discussionmentioning

confidence: 99%

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High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Charan

Kapoor²,

Singhal³

et al. 2014

Indian J Surg

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During surgery for colorectal cancer, the inferior mesenteric artery (IMA) may be ligated either directly at the origin of the IMA from the aorta (high ligation) or at a point just below the origin of the left colic artery (low ligation). Sixty patients of left colonic and rectal cancer undergoing elective curative surgery in 2007 and 2008 were selected for this observational study. The resected lymph nodes were grouped into three levels: along the bowel wall (D1), along IMA below left colic (D2), and along the IMA and its root (D3). Statistical analysis was performed with SPSS version 20.0. D2 level was involved pathologically in 20 (33.3 %) and D3 in six out of 44 (13.6 %) patients. The median nodal yield with high and low ligation were 33 and 25, respectively (p= 0.048). Median overall survival for high ligation was 62 months versus 42 months for low ligation (p=0.190). High ligation of the IMA for rectal and left colonic cancers can improve lymph node yield, thus facilitating accurate tumor staging and thus better disease prognostication, but the survival benefit is not significant.

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Section: Discussionmentioning

confidence: 99%

“…Colonic lymph nodes follow the arterial supply, thus high ligation can remove the highest draining nodes that may harbor occult microscopic metastases. Enker et al adhered to this principle strictly and reported 5-year disease-free survival rates of up to 70 % in stage III [6].…”

Section: Discussionmentioning

confidence: 99%

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Charan

Kapoor²,

Singhal³

et al. 2014

Indian J Surg

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“…For example, Dworkin et al [11] and Seike et al [12] used Doppler flowmetry to demonstrate that IMA clamping resulted in a >50% blood-flow reduction to the anastomosis, and a randomised controlled trial by Tocchi et al [23] reported that anastomotic leakages were significantly more frequent following HL of the IMA for diverticular disease in the left colonthan the preservation of the IMA and the LCA. Corder et al [24] and Hall et al [25] reported that HL of the IMA does not affect anastomotic leakage rates in the context of oncologic surgeries, while Kobayashi et al [19] and Sekimoto et al [20] demonstrated that operative results were not significantly different when comparing HL of the IMA and the preservation of the IMA and the LCA during laparoscopic surgeries.…”

Section: Discussionmentioning

confidence: 99%

Oncological Impact of Laparoscopic Lymphadenectomy with Preservation of the Left Colic Artery for Advanced Sigmoid and Rectosigmoid Colon Cancer

et al. 2014

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Background: Laparoscopic lymphadenectomy around the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) remains a controversial approach. The aim of the study was to investigate the clinical outcomes. Methods: This study analysed 211 patients who underwent laparoscopic resection of advanced (≥T3) sigmoid and rectosigmoid colon cancers with D3 lymphadenectomy including 91 high ligations of the IMA (HL) and 120 low ligations with preservation of the LCA (LL) from January 1998 to December 2009. Results: There were no significant differences in operative result between the groups. In stage II cancer, the overall survival rate (94.8% HL vs. 91.8% LL; 95% confidence interval (CI), -0.8 to 0.68, p = 0.920) and disease-free survival (93.0% HL vs. 87.6% LL; 95% CI, -0.8 to 0.40, p = 0.540) did not differ significantly between the two groups. A similar tendency in overall survival was observed in patients with stage III cancer (88.3% HL vs. 86.9% LL; 95% CI, -0.44 to 0.57, p = 0.989) and disease-free survival (71.4% HL vs. 69.8% LL; 95% CI, -0.38 to 0.40, p = 0.637). Conclusions: Laparoscopic lymphadenectomy around the IMA with preservation of the LCA resulted in acceptable clinical outcomes in patients with advanced sigmoid and rectosigmoid colon cancer.

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“…The practice of ligating the inferior mesenteric artery flush with the aorta may at times facilitate the lowering of the left colon and the performance of a sphincter-saving procedure, but it has failed repeatedly [25, 31, 32]to improve survival regardless of the stage of the disease [33]and to reduce the LR rate. The results suggest that metastatic involvement of lymph nodes at a level near the aorta indicates that further proximal spread may have already occurred [22].…”

Section: The Operationmentioning

confidence: 99%

Locally Recurrent Rectal Cancer

Radice

Dozois²

2001

Dig Surg

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Local recurrence (LR) varies from less than 4% to greater than 50%; several tumor factors and operative techniques may influence rate of LR. Of greatest interest has been the considerable inter-surgeon variation, even within the same institution. An LR rate of less than 10% has been consistently reported by those who use total mesorectal excision even without any form of adjuvant therapy, either preoperatively or postoperatively. These findings raise important questions about surgical technique, subspecialty teaching, place of adjuvant therapy and quality assurance. The management of LR by a multispecialty team and multimodality treatment including preoperative chemoradiation, surgical resection and intraoperative radiotherapy provides encouraging results in terms of better local control and prolonged survivorship in carefully selected patients. These uncontrolled results justify further evaluation of these salvage operations in a more controlled manner that should include repercussions on the quality of life of the patients.

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Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma

Cited by 83 publications

References 6 publications

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit

Oncological Impact of Laparoscopic Lymphadenectomy with Preservation of the Left Colic Artery for Advanced Sigmoid and Rectosigmoid Colon Cancer

Locally Recurrent Rectal Cancer

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