Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches

Bertrand, Martin; Delmond, Laure; Mazars, Romain; Ripoche, J.; Macrì, Francesco; Prudhomme, Michel

doi:10.1007/s00276-014-1281-y

Cited by 32 publications

(33 citation statements)

References 19 publications

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“…These papers are difficult to compare because different classification [13]. In a series of 117 patients, Bertrand, et al used Zebrowski's classification, which consisted of eight types [1]. They observed a fan-shaped branching pattern in approximately 20 % of the cases, which is comparable to the 29 % we found in the present study.…”

Section: Discussionsupporting

confidence: 90%

“…The use of the branching pattern of the LCA to evaluate the surgical difficulties of the LT technique has been investigated in a few studies [1,10]. These papers are difficult to compare because different classification [13].…”

Section: Discussionmentioning

confidence: 99%

“…The cancer-related advantages of the HT technique have not been proven, and defenders of the LT technique insist on an improved vascularization of anastomosis as well as a potential lower chance of anastomotic leakage with comparable survival. There is still some debate as to the expertise that is required to perform a laparoscopic LT, especially in the case of a fatty mesocolon [1]. Good anatomical knowledge of this area is mandatory to preserve the colic artery via the LT technique for tumors in the sigmoid colon and rectum [2,3,6].…”

Section: Introductionmentioning

confidence: 99%

“…Such a double IMV section is used to obtain a longer colon limb after vascular ligation and splenic flexure mobilization [3]. Technical difficulties during LCA preservation may be described using Latarjet's classification, which is based on the different IMA branching patterns [1,16]. However, the relationships between the IMV and LCA have not been well studied.…”

Section: Introductionmentioning

confidence: 99%

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Technical difficulties of left colic artery preservation during left colectomy for colon cancer

et al. 2015

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Technical difficulties of left colic artery preservation during left colectomy for colon cancer

et al. 2015

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“…This did not significantly increase total operating time. Some studies30 31 have reported that an IMA branching pattern with a large distance between the origins of the IMA and LCA causes technical difficulty. It would appear that surgeons should not hesitate to change the tie level of the IMA when performing a difficult low‐tie ligation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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).

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The sigmoidea ima artery: A player in colonic ischemia?

2020

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Introduction The sigmoidea ima artery is defined as the lowest sigmoid artery, which forms the distal end of the marginal artery by linking with the superior rectal artery. It supplies the rectosigmoid junction, which is a critical area for ischemia. The aim of the present study was to delineate the area supplied by the inferior mesenteric artery with special consideration of the sigmoidea ima artery. Materials and Methods The inferior mesenteric artery was dissected from its origin to the bifurcation of the superior rectal artery in 30 cadavers (15 male, 15 female). Vessel length and distance to the promontory were measured for each branch. Results There were two manifestations of the sigmoidea ima artery, irrespective of the branching pattern of the inferior mesenteric artery. It originated below the promontory in 25 cases (83.3%) and above it in three (10%). It did not derive from the superior rectal artery in two cases (6.7%). In these 16.7%, the marginal artery was absent near the rectosigmoid junction. Conclusions We suggest the terms “arteria sigmoidea ima pelvina” and “arteria sigmoidea ima abdominalis” for the two variants. The terms “arteria marginalis pelvina” and “arteria marginalis abdominalis” could be applied in clinical practice. An abdominal marginal artery could be considered a risk factor for colonic ischemia in colorectal resections and abdominal aortic aneurysm repair. Both variants should be considered when pre‐ and intra‐operative perfusion measurements are interpreted.

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Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches

Abstract: The division branches of the IMA are extremely subject to interindividual variations, making it difficult if not impossible to reproduce identically a surgical procedure based on their anatomy. HT appears to us as the only relevant procedure for colorectal cancer.

Cited by 32 publications

References 19 publications

Technical difficulties of left colic artery preservation during left colectomy for colon cancer

Technical difficulties of left colic artery preservation during left colectomy for colon cancer

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

The sigmoidea ima artery: A player in colonic ischemia?

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