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

Charan, Ishwar; Kapoor, Akhil; Singhal, Mukesh Kumar; Jagawat, Namrata; Bhavsar, Deepak; Jain, Vikas; Kumar, Vanita; Kumar, Harvindra Singh

doi:10.1007/s12262-014-1179-2

Cited by 26 publications

(15 citation statements)

References 14 publications

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“…Ligation of the inferior mesenteric artery (IMA) could be applied without any clinical consequences. Surgeons ligate IMA 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) [ 47 ]. There are two arterial arches between the middle colic artery (branch of the superior mesenteric artery) and the left colic artery (branch of the inferior mesenteric artery), which maximally keep the blood supply to the descending colon after high ligation of the IMA.…”

Section: Discussionmentioning

confidence: 99%

Ovarian Carcinosarcoma with Retroperitoneal Para-Aortic Lymph Node Dissemination Followed by an Unusual Postoperative Complication: A Case Report with a Brief Literature Review

et al. 2020

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Introduction. Ovarian carcinosarcoma (OCS), also known as malignant mixed Müllerian tumour (MMMT), is one of the rarest histological subtypes of ovarian cancer. It is an aggressive tumour with a dismal prognosis—the median survival of patients is less than two years. The rarity of the disease generates many controversies about histogenesis, prognostic factors and treatment of OCS. Histologically, OCS is composed of an epithelial and sarcomatous component. Case report. In the present case, a patient with bilateral ovarian cysts and bulky paraaortic lymph nodes is reported. Retroperitoneal paraaortic lymph node metastases were the only extrapelvic dissemination of OCS. The patient underwent comprehensive surgical staging procedures, including total abdominal hysterectomy and bilateral salpingo-oophorectomy, supracolic omentectomy and selective para-aortic lymphadenectomy. Histologically the ovarian carcinosarcoma was composed of an epithelial component (high-grade serous adenocarcinoma) and three sarcomatous components (homologous—endometrial stromal cell sarcoma, and heterologous—chondrosarcoma, rhabdomyosarcoma). Immunohistochemistry staining was performed. A postoperative complication (adhesion between the abdominal aorta and terminal ileum causing obstructive ileus) that has never been reported in the medical literature occurred. Conclusion. Carcinosarcomas are carcinomas with epithelial–mesenchymal transition and heterologous differentiation. Retroperitoneal pelvic and paraaortic lymph nodes should be carefully inspected in patients with ovarian tumours. Adhesions between the small bowels and abdominal aorta are possible complications after lymph node dissection in the paraaortic region.

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Section: Discussionmentioning

confidence: 99%

Ovarian Carcinosarcoma with Retroperitoneal Para-Aortic Lymph Node Dissemination Followed by an Unusual Postoperative Complication: A Case Report with a Brief Literature Review

et al. 2020

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“…In this included 5 studies, Slanetz and Grimson [ 7 ] and Charan [ 8 ] have shown the results in which the high ligation associated with more extensive resection of mesentery and its lymphatic drainage. It also has clinical significance to reduce local tumor recurrence and increases the oncological survival rate.…”

Section: Discussionmentioning

confidence: 99%

The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery

Singh

Luo²,

Liu

et al. 2017

Medicine

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Background:The decision of ligation at the origin of the inferior mesenteric artery (IMA) or below the origin of the left colic artery (LCA) has remained a dilemma for surgeons in colorectal cancer surgery. The available studies are controversial. The objective of this meta-analysis is to compare the predictive significance of high versus low ligation in colorectal cancer surgery.Methods:A literature search done using Medline, EMBASE, GoogleScholar, and references. A meta-analysis was performed to analyze the 5-year overall survival (OS) of the high and low ligation using hazard ratio (HR) and 95% confidence interval (CI). We further analyzed 2 subgroups considering the level of lymph nodes (LNs) extension. That is IMA positive (+ve) and negative (−ve) LNs. Survival differences were analyzed.Results:A total of 3119 patients in 5 cohorts were included in this meta-analysis. The pooled HR results showed significant OS benefit of high ligation than low ligation (HR; 0.77, 95% CI: 0.66–0.89) in the “IMA +ve” group with 33% decreased risk, while there is no statistical significance in the “IMA −ve” (HR 0.66, 95% CI: 0.30–1.46) and the “all cases” group (HR 0.69, 95% CI: 0.41–1.15).Conclusion:The pooled data showed high ligation of IMA has a better survival benefit for the patients with IMA positive LNs. It signifies high ligation should be recommended for the advanced cases or with the suspected high risk of IMA lymphatic metastasis. The limited number of articles demands future high-powered, well-designed randomized controlled trials (RCTs) for the further reliable conclusion.

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“…Of the 20 cohort studies, 11 studies had high quality with achieving 7 or more stars. [19,20,24,25,28,32,34,36,37,40,41] The 4 RCTs had medium or high quality. [22,30,31,39]…”

Section: Quality Judgment Of Studiesmentioning

confidence: 99%

Preservation versus non-preservation of left colic artery in colorectal cancer surgery

Yang

Zhang

et al. 2019

Medicine

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

Cited by 26 publications

References 14 publications

Ovarian Carcinosarcoma with Retroperitoneal Para-Aortic Lymph Node Dissemination Followed by an Unusual Postoperative Complication: A Case Report with a Brief Literature Review

Ovarian Carcinosarcoma with Retroperitoneal Para-Aortic Lymph Node Dissemination Followed by an Unusual Postoperative Complication: A Case Report with a Brief Literature Review

The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery

Preservation versus non-preservation of left colic artery in colorectal cancer surgery

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