The Rationale of High Vascular Ligation in Surgery For Left Sided Colon Cancer

Abstract

Background. The aim of the study was to evaluate the safety and adequacy of high vascular ligation while performing surgery for left-sided colon cancer. We performed a retrospective analysis of prospectively collected data of patients operated laparoscopically for sigmoid or descending colon cancer in a single tertiary care institution over a period of 10 years. Patients and methods. Between January 2007 and December 2016 hand-assisted laparoscopic surgery (HALS) was performed on 228 patients due to invasive and histologically verified descending or sigmoid colon cancer with high ligation of inferior mesenteric artery and vein. Patients who had carcinoma in situ were excluded. The following variables were collected and prospectively studied: age, sex, cancer localization, cancer stage, type of surgery, operative time, lymph node harvest, intraoperative complications, conversions, duration of hospital and postoperative stay, postoperative complications occurring within 30 days. Complications were assessed by Clavien- Dindo classification. Results. Patient mean age was 64±10 years (range, 40 - 86). There were 112 females (49.1 %) and 116 males (50.9 %). A total of 149 (65.5 %) sigmoid colectomies and 79 (34.5 %) left hemicolectomies have been performed. There were total of 71 (31 %) patients with stage I disease, 67 (29.7 %) – stage II, 65 (28.4 %) stage III and 25 (10.9 %) stage IV. Aerage operative time was 105±39 minutes (range, 45-270). Average harvested lymph node count was 16.5±10 (range, 10 - 90). Length of postoperative stay was 6.3±3.2 days (range, 1-30). Eleven (4.82 %) patients had complications, three of them (1,3%) were reoperated. There was no anastomotic leakage detected in this group of patients. Conclusions. Our data support the opinion, that high vascular ligation while performing surgery for left sided colon cancer is safe. Recorded lymphnode harvest confirms oncological adequacy of such an approach.