Low ligation inferior mesenteric artery versus selective sigmoidal artery ligation in sigmoid colon cancer: a comparative study

Background: Ligation at the root of the inferior mesenteric artery (IMA) or ‘high-tie’ is widely accepted during oncologic resection of sigmoid colon cancer surgery. However, IMA ligation may compromise the anastomotic blood supply and risk injury to autonomic nerve plexus. The preservation of IMA or ‘low-tie’ may lead to increase blood flow and decrease postoperative bowel complications, nevertheless require longer operative time and technical difficulties. This study aims to compare the results between laparoscopic sigmoidectomy with selective sigmoidal artery ligation (group A) and low-ligation IMA (group B).Methods: A 1:2 case-matched comparative study and retrospective review of 27 patients with sigmoid cancer (19 female and 8 male) who underwent laparoscopic sigmoidectomy between January 2012 to December 2015. There were 9 patients in group A and 18 patients in group B. Perioperative results were collected and follow-up was recorded at 6 and 12 months after surgery.Results: There were no difference in the mean operative time {group A 194.44 (+28.77), group B 178.89 (+55.52), p=0.349}, blood loss {group A 94.44 (+52.71), group B 79.44 (+58.15), p=0.51}, and mean numbers of harvested lymph nodes {group A 14.56 (+3.74), group B 17.56 (+7.64), p=0.183}. Three patients in group B experienced a short period of stool frequency (2-4 weeks postoperative) and one with constipation. No leakage, bleeding, or tumor recurrence occurred in both groups during the 1 year follow up.Conclusions: Laparoscopic sigmoidectomy with selective sigmoidal artery ligation and lymph node dissection allows equivalent short-term oncologic results to low-ligation IMA technique.

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Feasibility and oncologic safety of low ligation of inferior mesenteric artery with D3 dissection in cT3N0M0 sigmoid colon cancer

Annals of Surgical Treatment and Research ◽

10.4174/astr.2018.94.4.209 ◽

2018 ◽

Vol 94 (4) ◽

pp. 209 ◽

Cited By ~ 4

Author(s):

Kyung Ha Lee ◽

Jin Soo Kim ◽

Ji Yeon Kim

Keyword(s):

Colon Cancer ◽

Sigmoid Colon ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Sigmoid Colon Cancer ◽

Low Ligation

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Lack of Inferior Mesenteric Artery in a Sigmoid Colon Cancer

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.71.37 ◽

2018 ◽

Vol 71 (1) ◽

pp. 37-40

Author(s):

Sunao Ito ◽

Nobuhiro Haruki ◽

Hideki Tsuji ◽

Koshiro Harata

Keyword(s):

Colon Cancer ◽

Sigmoid Colon ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Sigmoid Colon Cancer

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A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease

Surgical Case Reports ◽

10.1186/s40792-021-01274-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kyoichi Kihara ◽

Hiromu Horie ◽

Kozo Miyatani ◽

Masayuki Endo ◽

Tomoyuki Matsunaga ◽

...

Keyword(s):

Colon Cancer ◽

Sigmoid Colon ◽

Peripheral Artery Disease ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Limb Ischemia ◽

Lower Limbs ◽

Sigmoid Colon Cancer ◽

Peripheral Artery ◽

Artery Disease

Abstract Background Colorectal cancer and peripheral artery disease are common conditions in older adults and may coexist in this population. Lymph node dissection along the inferior mesenteric artery is a vital procedure in cases of left-sided colorectal cancer. However, the inferior mesenteric artery may show a collateral blood pathway in rare cases of peripheral artery disease. We report a case of advanced sigmoid colon cancer in which the lower limbs received inferior mesenteric artery flow owing to asymptomatic peripheral artery disease. The possibility of catastrophic lower-limb ischemia because of complete mesenteric excision with ligation of the inferior mesenteric artery was a matter of concern in this case. Case presentation A 73-year-old man with asymptomatic peripheral artery disease was diagnosed with stage IIIB advanced sigmoid colon cancer. Angiography using a balloon-occlusion catheter revealed that his lower limbs received prominent inferior mesenteric artery blood flow through a collateral pathway. Therefore, interventional radiologists and cardiovascular surgeons evaluated the indications for endovascular stents or bypass grafts. The patient also had dilated cardiomyopathy, so the cardiovascular physicians evaluated his tolerance in the worst-case scenario of a colorectal anastomotic leak. The patient underwent axillofemoral artery bypass and two-stage laparoscopic sigmoid colectomy without anastomosis. The postoperative course was uneventful, and he resumed his job within a month after the resection. Conclusions Although collateral flow from the inferior mesenteric artery is rare in patients with peripheral artery disease, a few case reports have described fatal lower-limb ischemia following anterior resection. The perioperative multidisciplinary evaluation enabled us to understand the patient’s condition and risks, and allowed successful cancer treatment without ischemia of the lower limbs.

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A randomized clinical trial comparing the initial vascular approach to the inferior mesenteric vein versus the inferior mesenteric artery in laparoscopic surgery of rectal cancer and sigmoid colon cancer

Surgical Endoscopy ◽

10.1007/s00464-018-6551-z ◽

2018 ◽

Vol 33 (4) ◽

pp. 1310-1318

Author(s):

Pere Planellas ◽

Helena Salvador ◽

Ramon Farrés ◽

Núria Gómez ◽

David Julià ◽

...

Keyword(s):

Clinical Trial ◽

Rectal Cancer ◽

Colon Cancer ◽

Laparoscopic Surgery ◽

Randomized Clinical Trial ◽

Sigmoid Colon ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Sigmoid Colon Cancer ◽

Inferior Mesenteric Vein

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The Oncologic Outcomes of Inferior Mesenteric Artery-Preserving Laparoscopic Lymph Node Dissection for Upper-Rectal or Sigmoid Colon Cancer

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2018.0201 ◽

2018 ◽

Vol 28 (11) ◽

pp. 1352-1358 ◽

Cited By ~ 3

Author(s):

Yoshiaki Maeda ◽

Toshiki Shinohara ◽

Noriaki Futakawa ◽

Nozomi Minagawa ◽

Masao Sunahara ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Sigmoid Colon ◽

Lymph Node Dissection ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Oncologic Outcomes ◽

Sigmoid Colon Cancer ◽

Node Dissection

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Level of inferior mesenteric artery ligation does not affect rectal cancer treatment outcomes in spite of better cancer specific survival after low ligation – randomized trial results.

Colorectal Disease ◽

10.1111/codi.15798 ◽

2021 ◽

Author(s):

Wiesław Janusz Kruszewski ◽

Mariusz Szajewski ◽

Maciej Ciesielski ◽

Tomasz Buczek ◽

Krzysztof Kawecki ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Treatment ◽

Randomized Trial ◽

Treatment Outcomes ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Artery Ligation ◽

Cancer Specific Survival ◽

Rectal Cancer Treatment ◽

Low Ligation

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The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer

International Journal of Colorectal Disease ◽

10.1007/s00384-008-0465-5 ◽

2008 ◽

Vol 23 (8) ◽

pp. 783-788 ◽

Cited By ~ 53

Author(s):

Chih-Chien Chin ◽

Chien-Yuh Yeh ◽

Reiping Tang ◽

Chung-Rong Changchien ◽

Wen-Shih Huang ◽

...

Keyword(s):

Colon Cancer ◽

Surgical Treatment ◽

Sigmoid Colon ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

High Ligation ◽

Sigmoid Colon Cancer

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High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection

Frontiers in Surgery ◽

10.3389/fsurg.2021.756873 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jun Higashijima ◽

Toru Kono ◽

Mitsuo Shimada ◽

Ayumu Sugitani ◽

Hideya Kashihara ◽

...

Keyword(s):

Sigmoid Colon ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Rectal Resection ◽

High Ligation ◽

Vascular Perfusion ◽

Artery Ligation ◽

Ileocolic Artery ◽

Anterior Rectal Resection ◽

Low Ligation

Background: Anastomotic leakage (AL) after colorectal surgery is associated with insufficient vascular perfusion of the anastomotic ends. This study aimed to evaluate the effect of high vs. low ligation of the ileocolic artery and inferior mesenteric artery, respectively, on the vascular perfusion of the bowel stumps during ileocecal resection (ICR) and anterior rectal resection (AR).Methods: We retrospectively evaluated patients who underwent ICR or AR between 2016 and 2020. Real-time indocyanine green fluorescence angiography was performed to measure the fluorescence time (FT) as a marker of the blood flow in the proximal and distal stumps before anastomosis.Results: Thirty-four patients with lower right-sided colon cancer underwent laparoscopic ICR. Forty-one patients with rectosigmoid colon or rectal cancer underwent robotic high AR (HAR) (n = 8), robotic low AR (LAR) (n = 6), laparoscopic HAR (n = 8), or laparoscopic LAR (n = 19). The FT was similar in the ileal and ascending colon stumps (p = 1.000) and did not differ significantly between high vs. low ligation of the ileocolic artery (p = 0.934). The FT was similar in the sigmoid colon and rectal stumps (p = 0.642), but high inferior mesenteric artery ligation significantly prolonged FT in the sigmoid colon during AR compared with low ligation (p = 0.004), indicating that the high ligation approach caused significant hypoperfusion compared with low ligation. The AL rate was similar after low vs. high ligation.Conclusions: Low vascular perfusion of the bowel stumps may not be an absolute risk factor for AL. High inferior mesenteric artery ligation could induce sigmoid colon stump hypoperfusion during anterior rectal resection.

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