Apical lymph nodes at the root of the inferior mesenteric artery in distal colorectal cancer: an analysis of the risk of tumor involvement and the impact of high ligation on anastomotic integrity

2010 ◽  
Vol 14 (1) ◽  
pp. 1-8 ◽  
Author(s):  
A. Alici ◽  
M. Kement ◽  
C. Gezen ◽  
T. Akın ◽  
S. Vural ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Nodes ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
High Ligation ◽  
Tumor Involvement ◽  
Apical Lymph Nodes ◽  
The Impact

Outcomes of level of ligation of inferior mesenteric artery in colorectal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Pavan Kumar Jonnada ◽  
Monish Karunakaran ◽  
Dayakar Rao
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Anastomotic Leak ◽  
Mesenteric Artery ◽  
Fixed Effects ◽  
Inferior Mesenteric Artery ◽  
Meta Analysis ◽  
High Ligation ◽  
Recurrence Rates ◽  
Low Ligation

The level of ligation of the inferior mesenteric artery (IMA) is a critical factor that can influence outcomes. The aim of this meta-analysis was to compare outcomes following high or low ligation of IMA. A systematic search was performed for relevant articles published between 2000 and 2020. Meta-analysis was performed using fixed-effects or random-effects models; 31 studies were included. Results show significantly lower rates of anastomotic leak, postoperative morbidity and urinary dysfunction with low ligation compared with high ligation. Though recurrence rates were similar, 5-year overall survival was longer in the low ligation group. Low ligation of IMA decreases anastomotic leak rates and overall morbidity. Addition of IMA nodal clearance to low ligation appears to improve overall survival in colorectal cancer.

scholarly journals A Short-Term Outcome on Ligating the Different Levels of the Inferior Mesenteric Artery (IMA). A Prospective Cohort Study.

2021 ◽  
Author(s):  
Dujanand Singh ◽  
He Long ◽  
Lie Yang ◽  
wang Cun ◽  
Yongyang Yu ◽  
...  
Keyword(s):  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Histopathological Examination ◽  
High Ligation ◽  
Main Concern ◽  
Term Outcome ◽  
Colorectal Cancer Surgery ◽  
Anastomosis Leakage ◽  
Low Ligation ◽  
The Impact

Abstract Background: This study is to analyze the impact on the level of Inferior mesenteric artery (IMA) ligation of Colorectal cancer surgery. The retrieval of lymph nodes (LNs) and anastomotic leakage was the main concern of this study. Methods: In this prospective study, the high and low ligation cases were selected. The retrieved LNs from roots of the inferior mesenteric artery (IMA) and left colic artery (LCA) was sent for histopathological examination (HPE), irrespective of the method of ligation. The observation of HPE results and Anastomosis leakage were analyzed.Result: In the total numbers of 369 cases, 12 cases were cancer positive LNs at the root of IMA despite 349 harvested LNs. On another hand, just one case showed LCA positive LNs obliviously because just 12 cases were had harvested LNs at the root of LCA. where Two cases of leakage were seen in both groups over a three-month follow-up. Conclusions: This result signifies the importance of IMA root LNs clearance and concern of high ligation. However, the small number of cases demand further well-designed RCTs to make an evidence-based decision.

scholarly journals Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Tzu-Chieh Yin ◽  
Yen-Cheng Chen ◽  
Wei-Chih Su ◽  
Po-Jung Chen ◽  
Tsung-Kun Chang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Sigmoid Colon ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Meta Analysis ◽  
High Ligation ◽  
Colon And Rectal Cancer ◽  
Rectal Cancers ◽  
Low Ligation

BackgroundWhether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies.MethodsPubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient’s perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4.ResultsA total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage (p < 0.001), borderline long operative time (p = 0.06), and less yields of total lymph nodes (p = 0.03) but equivalent IMA root lymph nodes (p = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes.ConclusionIn comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique.Systematic Review RegistrationINPLASY.com, identifier 202190029.

scholarly journals The New Concept of Physiological “Riolan’s Arch” and the Reconstruction Mechanism of Pathological Riolan’s Arch After High Ligation of the Inferior Mesenteric Artery by CT Angiography-Based Small Vessel Imaging

2021 ◽  
Vol 12 ◽  
Author(s):  
Ying Wang ◽  
Weibin Shu ◽  
Aimie Ouyang ◽  
Lei Wang ◽  
Yuping Sun ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Splenic Flexure ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Three Dimensional ◽  
High Ligation ◽  
Colic Artery ◽  
Left Colic Artery ◽  
Pathological Conditions ◽  
Anatomical Classification

BackgroundDue to the complexity of anatomical relationship between superior mesenteric artery (SMA) and left colic artery (LCA), there is no unified anatomical concept of “Riolan’s arch.” There is no consensus as to tie off the inferior mesenteric artery (IMA) at its origin or just below the origin of the left colic artery during radical surgery of sigmoid colon and rectal cancers. The aim of the study is to investigate the anatomy of shortcut anastomotic branches (adjacent branches) of SMA at splenic flexure and to explore how the shortcut pathway (Riolan’s arch) was formed, as the compensation of anastomotic branches between MCA and LCA under pathological conditions and the reconstruction and the mechanism of pathological Riolan’s arch after high ligation of the inferior mesenteric artery.MethodsBetween January 2018 and May 2020, patients with colorectal cancer who underwent CTA before surgery were enrolled in the study. The anatomy of shortcut anastomotic branch of SMA and LCA was investigated by volume rendering technique (VR) and maximum-intensity projection (MIP). GE’s small vessel extraction technology (selected VR) was used to directly display these shortcut anastomotic branches on a map and to establish their three-dimensional anatomical classification. Then, we used the axonometric drawing to make the model more exact. Next, combining with some cases of pathological Riolan’s arch and basing on hydrodynamic principle, we speculate the mechanism of collateral circulation. Finally, based on the retrospective study of high ligation cases and combined principles of fluid mechanics, we show how these shortcut anastomotic branches evolved into Riolan’s arch.ResultsWe report the classification of the ascending branch of LCA (which approaches the splenic flexure) and the left branch of MCA, display these shortcut anastomotic branches on a map, and establish their three-dimensional anatomical classification. We found that Riolan’s arch is a shortcut pathway for the compensation of anastomotic branches, between MCA and LCA under pathological conditions, and that the formation mechanism of shortcut path accords with the principle of hydrodynamics.ConclusionsOur results show the mechanism of pathological Riolan’s arch formation and provide new anatomic thinking for the battle between high and low ligation of IMA in colorectal cancer surgery.

scholarly journals Impact of Inferior Mesenteric Artery Lymph Node Metastasis on the Prognosis of Patients With Left-sided Colorectal Cancer: A Case Control Study

2020 ◽  
Author(s):  
Kazuya Takabatake ◽  
Tomohiro Arita ◽  
masayoshi Nakanishi ◽  
Yoshiaki Kuriu ◽  
Yasutoshi Murayama ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Stage Iv ◽  
Stage Iii ◽  
Node Metastasis ◽  
Significant Difference

Abstract Background: The clinical significance of metastasis in inferior mesenteric artery (IMA) lymph node in patients with left-sided colorectal cancer (LCRC) is unclear. The aim of this study was to investigate the impact of IMA lymph node metastasis (IMA-LN (+)) on the prognosis of patients with LCRC. Methods: A total of 292 patients with stage III LCRC and 111 patients with stage IV LCRC who underwent radical resection of the primary tumor between 2005 and 2016 were included. The clinicopathological features and prognosis, which were retrospectively obtained from medical records, were compared regarding IMA-LN (+). Results: IMA-LN (+) was observed in 10 patients with stage III LCRC (2.3%). Moreover. ≥4 metastatic lymph nodes (p = 0.001) and poorly differentiated type (p = 0.049) were more frequently observed in patients with IMA-LN (+) than in patients without IMA lymph node metastasis (IMA-LN (-)) in stage III; IMA-LN (+) patients had significantly worse overall survival (OS) than IMA-LN (-) patients in stage III (p = 0.015). Conversely, there was no significant difference between the OS of stage III IMA-LN (+) and stage IV patients (p = 0.192). Likewise, there was no significant difference between the OS of stage III IMA-LN (+) and stage IV patients with distant metastatic lymph nodes only (n = 12) (p = 0.294). Conclusion: The prognosis of IMA-LN (+) patients was worse than that of IMA-LN (-) patients in stage III LCRC; moreover, it was similar to that of patients with stage IV LCRC.

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