Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma

Uehara, K.; Yamamoto, Seiichiro; Fujita, Shin; Aoki, Takayuki; Moriya, Yoshihiro

doi:10.1159/000107779

Cited by 56 publications

(64 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In rectal cancer surgery, the level of IMA ligation has always been debated [5,7,10,19,20] . Although dividing the IMA is a tiny issue for rectal cancer surgery, there is still no consensus.…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery

Matsuda

Yokoyama

Hotta

et al. 2017

Gastrointest Tumors

View full text Add to dashboard Cite

Background: The level of inferior mesenteric artery (IMA) ligation for anterior resection of rectal cancer has several considerations concerning oncological outcomes. The primary endpoint of this randomized controlled trial (RCT) was to assess bowel function between high and low ligation. This study was intended to clarify oncological outcome as the secondary endpoint. Objective: The aim of this study was to assess in a prospective RCT whether the ligation level of the IMA in rectal cancer influences oncological outcomes. Methods: Between February 2008 and December 2011, 100 patients who underwent anterior resection for rectal cancer were randomized to perform either high or low ligation of the IMA. Oncological outcomes was the secondary endpoint of this RCT, whereas assessing bowel function was the primary endpoint. This RCT was registered at clinicaltrials.gov (NCT00701012). Results: There were no differences between the groups in terms of clinical data except for tumor stage. There were more advanced-stage patients in the high ligation group (p = 0.046). There were no lymph node (LN) metastases in the root of the IMA in the high ligation group. The average number of harvested LNs for the high and low ligation groups was 16.7 and 14.9, respectively. There was no difference in disease-free survival (DFS), site of first recurrence, and overall survival (OS). When patients were in stage III, there was also no difference in DFS and OS. Conclusions: The ligation level of the IMA in rectal cancer may not influence oncological outcomes. However, further large-scale RCTs are needed to conclude this issue.

show abstract

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery

Matsuda

Yokoyama

Hotta

et al. 2017

Gastrointest Tumors

View full text Add to dashboard Cite

show abstract

“…High‐tie ligation has been advocated1, 2, 3, 4, 5, 6 because it allows more radical resection and more accurate pathological staging. Others7, 8, 9, 10, 11, 12, 13 favour low‐tie ligation because of increased blood flow to the proximal end of the anastomosis. This debate goes all the way back to the descriptions by Miles14 and Moynihan15 in 1908.…”

Section: Introductionmentioning

confidence: 99%

“…This debate goes all the way back to the descriptions by Miles14 and Moynihan15 in 1908. Recent studies7, 8, 9, 10 have recommended low tie, as there was no significant difference in survival rates between high‐ and low‐tie ligation.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

et al. 2018

View full text Add to dashboard Cite

BackgroundThe optimal level for inferior mesenteric artery ligation during anterior resection for rectal cancer is controversial. The aim of this randomized trial was to clarify whether the inferior mesenteric artery should be tied at the origin (high tie) or distal to the left colic artery (low tie).MethodsPatients were allocated randomly to undergo either high‐ or low‐tie ligation and were stratified by surgical approach (open or laparoscopic). The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were duration of surgery, blood loss and 5‐year overall survival.ResultsSome 331 patients entered the trial between June 2006 and September 2012. The trial was stopped prematurely as recruitment was slow. Seven patients were excluded after randomization but before operation because of procedural changes. High tie and low tie were performed in 164 and 160 patients respectively. The incidence of anastomotic leakage was not significantly different (17·7 versus 16·3 per cent respectively; P = 0·731). The incidence of severe complications requiring intervention was 2·4 versus 5·0 per cent for high and low tie respectively (P = 0·222). In multivariable analysis, risk factors for anastomotic leakage included male sex (odds ratio 4·36, 95 per cent c.i. 1·56 to 12·18) and distance of the tumour from the anal verge (odds ratio 0·99, 0·98 to 1·00). At 5 years there were no significant differences in overall (87·2 versus 89·4 per cent respectively; P = 0·386) and disease‐free (76·3 versus 77·6 per cent; P = 0·765) survival.ConclusionThe level of ligation of the inferior mesenteric artery does not significantly influence the rate of anastomotic leakage. Registration number: NCT01861678 ( https://clinicaltrials.gov).

show abstract

“…21 Moreover, the incidence of IMA lymph node metastasis was 4.79% in our study and was reported in previous studies to be low, ranging from 0.3% to 8.6%. 16,20,22,23 This low incidence could also be one of the reasons that we and others could not demonstrate a survival benefit. Taken together, there is no conclusive evidence to support a survival benefit among patients who undergo removal of IMA lymph node by high ligation.…”

Section: Discussionmentioning

confidence: 69%

Inferior Mesenteric Artery Lymph Node Metastasis Is an Independent Prognostic Factor for Stage III Sigmoid Colon and Rectal Cancer

Hata

Takahashi

Haraguchi

et al. 2017

International Surgery

View full text Add to dashboard Cite

Abstract:Background: It is unclear whether the number or distribution of lymph node metastases can provide a more accurate prognosis. The aim of this study was to evaluate the prognostic impact of inferior mesenteric artery (IMA) lymph node metastasis (LNM) in sigmoid colon and rectal cancer. Methods: We included 188 patients who underwent curative resection for stage III sigmoid colon and rectal cancer between January 2001 and December 2012. Patients were divided into two groups based on the presence of IMA LNM (LNM-positive vs. LNM-negative group). Clinicopathological characteristics, 3-year recurrence-free survival and 5-year overall survival rates, and recurrence patterns were compared between the two groups. Results: Of 188 patients, nine patients (4.79%) were in the LNM-positive group. After curative resection, 3-year recurrence-free survival and 5-year overall survival rates were significantly lower in the LNM-positive group compared to the LNM-negative group (44.44% vs. 69.98%, p = 0.016 for 3-year recurrence-free survival and 48.61% vs. 81.73%, p = 0.018 for 5-year overall survival). Multivariate analysis revealed that the presence of IMA LNM (p = 0.04), not the number of LNMs (p = 0.153), was an independent prognostic factor for recurrence-free survival. The paraaortic lymph node metastasis rate was significantly higher in the LNM-positive group (p = 0.0078). Conclusions: IMA LNM is an independent predictor of survival for stage III sigmoid Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporationcolon and rectal cancer patients. Evaluation of IMA LNM enables accurate estimation of patient prognosis and enhances appropriate postoperative therapy. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Inferior Mesenteric Artery Lymph Node Metastasis Is an Independent

show abstract

Impact of Upward Lymph Node Dissection on Survival Rates in Advanced Lower Rectal Carcinoma

Cited by 56 publications

References 29 publications

Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery

Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

Inferior Mesenteric Artery Lymph Node Metastasis Is an Independent Prognostic Factor for Stage III Sigmoid Colon and Rectal Cancer

Contact Info

Product

Resources

About