Preservation of the Arterial Arc Formed by Left Colic Artery, Proximal Inferior Mesenteric Artery, and the First Branch of Sigmoid Arteries in Anus Saving Treatment of Low Rectal Cancer

Abstract

Background Low anterior, ultralow anterior, and intersphincteric resection are conventional, elective anus-sparing techniques for low rectal cancer, and good prognosis depends on a good blood supply and tension-free anastomosis. Aim The goal is to assess the effect of preserving the arc formed by the left colic and proximal inferior mesenteric arteries (IMAs), and first branch of the sigmoid arteries on the anastomotic blood supply, tension, and leakage rate in anus-sparing surgery for low rectal cancer. Method From 2011 to 2020, a patient with low rectal cancer resection was distributed into the ligation group (42 cases with inferior mesenteric artery ligation) and the preservation group (61 cases with preservation of the left colic and proximal IMAs and first branch of the sigmoid artery). Results We evaluated patient characteristics, operative results, morbidity, and postoperative follow-up results. There were comparable outcomes between ligation and preservation groups in relations to the number of patients in each operative procedure, duration of surgery, operative blood loss, postoperative hospital stay, and the number of patients with protective stoma ( P >.05). In postoperative morbidity, there were similar outcomes between ligation and preservation groups in terms of anastomotic subclinical dehiscence, bleeding and stricture, and urinary retention ( P >.05). There were significant differences in anastomotic leakage and intra-abdominal abscess ( P < .05). Conclusion Preservation of the arterial arc formed by left colic artery, proximal IMA, and the first branch of sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply, reduce anastomotic tension, and leakage rate in anus-saving treatment of low rectal cancer.

Efficacy of reinforcing sutures for prevention of anastomotic leakage after low anterior resection for rectal cancer: A systematic review and meta‐analysis

“…To reduce the incidence of anastomotic leakage, a tension‐free anastomosis is beneficial 26 . The double‐stapling technique has widely been used in rectal surgery.…”

“…To reduce the incidence of anastomotic leakage, a tension‐free anastomosis is beneficial. 26 The double‐stapling technique has widely been used in rectal surgery. Two corners made by crossing the circular and linear staple lines are weak; thus, reinforcing sutures are placed at the crossing point of the staple lines.…”

A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer

“…To ensure successful intraoperative vascular dissection, familiarity with variations of the sigmoid artery is crucial, or alternatively, using CT angiography may help. Care should be taken to prevent damage to the marginal artery when trimming the mesentery [ 30 ]. In our study, one patient had a marginal arterial arch injury, resolved by mobilizing the splenic region for a tension-free anastomosis.…”

Early Postoperative Low Compliance to Enhanced Recovery Pathway in Rectal Cancer Patients

“…New items reducing perioperative stress and invasiveness of surgery have been subsequently proposed [ 9 , 10 ]. Promising preliminary results have been obtained with low-pressure pneumoperitoneum, multimodal analgesia including abdominal wall blocks, and inferior mesenteric artery preservation in upper rectal cancer surgery [ 11 , 12 , 13 , 14 ].…”