1
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Yoshida D, Sugiyama M, Nakazono K, Oyama T, Hasegawa T, Kai S, Yamamoto M, Matsumoto T, Kawanaka H, Morita M, Toh Y, Yano T. Oncological Impact of the Level of Inferior Mesenteric Artery Ligation in Low Rectal Cancer Surgery. Anticancer Res 2023; 43:3225-3233. [PMID: 37351999 DOI: 10.21873/anticanres.16496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM This study aimed to evaluate the clinical impact of the level of inferior mesenteric artery (IMA) ligation in patients with advanced low rectal cancer. PATIENTS AND METHODS All enrolled patients (n=350) underwent curative resection of rectal cancer with D3 lymph node dissection, with either IMA (high-tie) or superior rectal artery (SRA) (low-tie) ligation. RESULTS There were 27 and 65 patients in the high-tie and low-tie groups, respectively. There was no significant difference in the postoperative complication rate. Postoperative anastomotic leakage developed in five patients in the low-tie group and none in the high-tie group. The overall recurrence rates were 37.0% (n=10) and 40.0% (n=26) in the high-tie and low-tie groups, respectively, with no significant difference between the two groups (p=0.748). Local recurrences and lymph node metastases developed in five and no patients in the high-tie group and in 13 and one patient in the low-tie group, respectively. In the multivariate analysis, pathological T4 and pathological N2 and N3 were independent poor prognostic factors for overall survival (OS), whereas left colic artery (LCA) preservation was not significant. CONCLUSION No significant difference in oncological outcomes was observed in advanced low rectal cancer surgery with respect to the level of the IMA ligation. Thus, the less complicated high-tie procedure should be adopted as a standard procedure.
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Affiliation(s)
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Tabito Oyama
- Department of Surgery, Beppu Medical Center, Oita, Japan
| | | | - Seiichiro Kai
- Department of Surgery, Beppu Medical Center, Oita, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | | | | | - Masaru Morita
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tokujiro Yano
- Department of Surgery, Beppu Medical Center, Oita, Japan
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2
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Hiranuma C, Ishiyama Y, Hirano Y, Hattori M, Douden K. D3 lymph node dissection with versus without left colic artery preservation in single-incision laparoscopic surgery for sigmoid and rectosigmoid cancer: A propensity score-matched analysis. Asian J Endosc Surg 2022; 16:233-240. [PMID: 36443942 DOI: 10.1111/ases.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/01/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE In surgery for colorectal cancer, dissection of the lymph nodes and fatty tissue around the root of the inferior mesenteric artery is important from an oncologic point of view. However, it is debatable whether it is better to preserve or remove the left colic artery (LCA). This study aimed to compare D3 lymphadenectomy with versus without LCA preservation in single-incision laparoscopic surgery for sigmoid and rectosigmoid cancer. METHODS A total of 1138 patients underwent surgery for colorectal cancer between April 2011 and December 2018 at Fukui Prefectural Hospital. This propensity score-matched retrospective study analyzed the data of 163 patients: 42 patients with LCA preservation (group A) and 129 without LCA preservation (group B). Clinical and oncological outcomes were compared between the two groups. RESULTS There were no significant differences between groups A and B in patient characteristics, surgical outcomes, including the 5-year overall survival rate (75% vs. 64.2%, hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.37-4.30), 5-year disease-free survival rate (85.7% vs. 85.7%, HR 0.99, 95% CI 0.24-4.22), and 5-year cancer-specific survival rate (92.8% vs. 89.3%, HR 1.50, 95% CI 0.25-11.4). CONCLUSION There were no significant differences in the short- and long-term outcomes of patients who underwent single-incision laparoscopic surgery with D3 lymphadenectomy with versus without LCA preservation. This suggests that LCA preservation is safe and feasible in single-incision laparoscopic surgery for sigmoid and rectosigmoid colon cancer.
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Affiliation(s)
| | - Yasuhiro Ishiyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yasumitu Hirano
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan.,Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Kenji Douden
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
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3
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Nozawa H, Okamoto K, Kawai K, Sasaki K, Emoto S, Murono K, Sonoda H, Ishihara S. Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon. ANZ J Surg 2022; 92:1760-1765. [PMID: 35412011 DOI: 10.1111/ans.17683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent descending mesocolon (PDM) is a fetal abnormality in which the left-sided colon is not fused to the retroperitoneum, and it is often accompanied by the adhesion between the mesocolon and small bowel mesentery. Due to its rarity, whether PDM exhibits anatomical characteristics of the inferior mesenteric artery (IMA) and left colic artery (LCA), and how the anomaly affects laparoscopic surgery are largely unknown. We investigated the branches of these arteries and outcomes of patients who underwent laparoscopic surgery. METHODS Based on computed tomography (CT) and three-dimensional CT angiography, branching patterns of the IMA, LCA and branches originating from the LCA were analysed in 954 patients with left-sided colon or rectal cancer. PDM was diagnosed by preoperative CT colonography, and confirmed at time of surgery. The anatomical features of the vessels and short-term outcomes of laparoscopic surgery were compared between patient groups stratified by PDM. RESULTS Twelve patients (1.3%) were diagnosed with PDM. No branching pattern of the IMA specific to PDM was noted. On the other hand, patients with PDM had fewer branches (mean: 1.0) from the LCA than those without PDM (mean: 1.8, p = 0.009). In patients undergoing laparoscopic surgery, outcomes such as operative time, intraoperative blood loss, and number of harvested nodes were comparable between the two patient groups. CONCLUSION Few branches of the LCA characterize PDM. PDM does not complicate laparoscopic surgery of the left-sided colon and rectum. However, the above anatomical feature increases the risk of poor colonic perfusion when dividing the LCA.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Okamoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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4
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Yin TC, Chen YC, Su WC, Chen PJ, Chang TK, Huang CW, Tsai HL, Wang JY. Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis. Front Oncol 2021; 11:774782. [PMID: 34858855 PMCID: PMC8632045 DOI: 10.3389/fonc.2021.774782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Background Whether 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. Methods PubMed, 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. Results A 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. Conclusion In 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 Registration INPLASY.com, identifier 202190029.
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Affiliation(s)
- Tzu-Chieh Yin
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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5
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Memar SA, Taylor AM, Ahuja S, Daly DT, Tan Y. Rare left colic artery variation of the gut arterial system. Folia Morphol (Warsz) 2021; 82:198-204. [PMID: 34845717 DOI: 10.5603/fm.a2021.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Most variations of the abdominal blood supply are related to branching of the coeliac trunk and superior mesenteric artery. This case details a remarkable variation in the branching pattern of the left colic artery (LCA) observed during routine cadaveric dissection of an 84-year-old male donor. An anomalous common trunk, originating from the common hepatic artery, gave rise to three branches: 1) an accessory posterior pancreaticoduodenal artery to the head of the pancreas and adjacent duodenum, 2) the dorsal pancreatic artery anastomosing with branches of the splenic artery, and 3) the LCA. The LCA descended between the splenic vein and superior mesenteric artery to supply the left colic flexure and form a collateral route with the middle colic artery by contributing to the marginal artery of Drummond. Knowledge of this variation is clinically relevant for surgical and radiological procedures in the abdomen.
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Affiliation(s)
- S A Memar
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, United States
| | - A M Taylor
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - S Ahuja
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - D T Daly
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States.
| | - Y Tan
- Centre for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, United States
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6
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Iida T, Murono K, Shiratori H, Nozawa H, Kawai K, Sasaki K, Emoto S, Kishikawa J, Ishii H, Yokoyama Y, Abe S, Nagai Y, Anzai H, Sonoda H, Takayama T, Hoshina K, Ishihara S. Impact of Inferior Mesenteric Artery Occlusion on the Calibre of Collateral Arteries of the Colon. Anticancer Res 2021; 41:5189-5193. [PMID: 34593471 DOI: 10.21873/anticanres.15337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The inferior mesenteric arteries (IMA) are occluded in some colorectal cancer patients. This study evaluated the impact of IMA occlusion on the calibre of collateral arteries. PATIENTS AND METHODS As an IMA obstruction model, 20 patients who underwent abdominal aortic aneurysm surgery, with ligated, excluded, or embolised IMA, were enrolled. Changes in the calibre of the left colic arteries (LCAs) and marginal arteries after surgeries were evaluated. RESULTS The cross-sectional area of the LCA significantly increased after surgery (4.34 mm2 vs. 6.34 mm2, p=0.0009) and that of the marginal artery did not change significantly (2.69 mm2 vs. 3.01 mm2, p=0.33). CONCLUSION The calibre of the LCA increased after IMA occlusion. The descending branch of the LCA should be confirmed preoperatively to preserve blood flow during a low tie procedure.
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Affiliation(s)
- Tetsuhiro Iida
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan;
| | - Hiroshi Shiratori
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Junko Kishikawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Department of Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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7
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Kigata T, Shibata H, Kobayashi Y. Arterial supply to the rat colon. Anat Histol Embryol 2021; 50:853-860. [PMID: 34414598 DOI: 10.1111/ahe.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
Rats are often used as animal models in studies such as on intestinal transplantation and anastomosis healing, which require colectomy. Although detailed information regarding arterial supply is important to establish accurate and reproducible experimental procedures, this has not been studied in the rat colon. Therefore, we analysed the detailed arterial distribution pattern and its individual variations in the colon of 34 rats. The rat colon received colic branches of the ileocolic artery, and the right, middle and left colic arteries. The single left colic artery constantly arose from the caudal mesenteric artery and was distributed to the descending colon, whereas the others showed variations in number and distribution. The ileocolic artery gave rise to one (12%) or two (88%) colic branches supplying the proximal ascending colon, and these branches formed rich, mesh-like anastomoses along the initial portion of the ascending colon. One (74%) or two (26%) right colic arteries originated from the cranial mesenteric artery and supplied the ascending colon and right colic flexure. Moreover, one (38%), two (56%) or three (6%) middle colic arteries emerged from the cranial mesenteric artery and were distributed to the transverse colon, left colic flexure and proximal descending colon. In total, we categorized the individual variations in arterial branching and anastomosis into 11 patterns. Arterial supply to the rat colon showed a specific pattern and frequent individual variations. These findings thus provide essential information for establishing reproducible models of rat colic surgery.
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Affiliation(s)
- Tetsuhito Kigata
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Japan.,Laboratory of Veterinary Anatomy, Faculty and Institute of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Hideshi Shibata
- Laboratory of Veterinary Anatomy, Faculty and Institute of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Yasushi Kobayashi
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Japan
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8
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Wang Y, Shu W, Ouyang A, Wang L, Sun Y, Liu G. 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. Front Physiol 2021; 12:641290. [PMID: 34239446 PMCID: PMC8257958 DOI: 10.3389/fphys.2021.641290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Due 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. Methods Between 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. Results We 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. Conclusions Our 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.
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Affiliation(s)
- Ying Wang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Weibin Shu
- Tumor Research and Therapy Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Aimie Ouyang
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lei Wang
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuping Sun
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guoqin Liu
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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9
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Luo Y, Yu MH, Huang YZ, Jing R, Qin J, Qin SL, Shah JN, Zhong M. Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers. Cancer Manag Res 2021; 13:3963-3971. [PMID: 34017199 PMCID: PMC8131009 DOI: 10.2147/cmar.s282986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Preservation of the left colic artery in low-tie (LT) of inferior mesenteric artery remains controversial compared to high-tie (HT) in the colon and rectal cancers, for lymph node dissection, anastomotic leakage, and oncological outcome. This cohort study aims to analyze short- and long-term outcomes of laparoscopic anterior resections in LT vs HT for rectal cancers. Methods We analyzed a cohort of laparoscopic AR for RC from 2013 to 2016 at Renji Hospital, Shanghai, China. Short- and long-term outcome in LT vs HT group were compared for clinico-demographic characteristics, operative-time, lymph node dissection, short-term 30-day outcome, and long-term 3- and 5-year overall survival as well as disease-free survival. The x2, t-test, and logistic regressions analysis were used and p<0.05 was considered significant. Results The cohort consisted of 614 laparoscopic AR with LT (236) and HT (378). The clinicodemographic characteristics were comparable among the groups. The surgery took longer in LT. The yield of LND was similar. Leakage occurred in 12.21% (n=75). Leakage was fewer in LT than HT, 8.89% vs 14.28%, p=0.047. The postoperative severe complications were higher in HT. The 30-day mortality was nil. The long-term 3- and 5-year overall survival and disease-free survival were similar in LT and HT. Conclusion The LT with preservation of left colic artery had similar lymph node yield, but lower leakage and complications than HT in laparoscopic anterior resections for rectal cancers. The long-term 3- and 5-year overall and disease-free survival were similar in the two groups.
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Affiliation(s)
- Yang Luo
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Min-Hao Yu
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yi-Zhou Huang
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Ran Jing
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Jun Qin
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Shao-Lan Qin
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Jay N Shah
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China.,Department of Surgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Kathmandu, 44700, Nepal
| | - Ming Zhong
- Department of Gastrointestinal Surgery, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
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10
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Petzold S, Storsberg SD, Fischer K, Schumann S. Variant Arterial Supply of the Descending Colon by the Coeliac Trunk: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050487. [PMID: 34066117 PMCID: PMC8151744 DOI: 10.3390/medicina57050487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022]
Abstract
Background and Objectives: Knowledge of arterial variations of the intestines is of great importance in visceral surgery and interventional radiology. Materials and Methods: An unusual variation in the blood supply of the descending colon was observed in a Caucasian female body donor. Results: In this case, the left colic artery that regularly derives from the inferior mesenteric artery supplying the descending colon was instead a branch of the common hepatic artery. Conclusions: Here, we describe the very rare case of an aberrant left colic artery arising from the common hepatic artery in a dissection study.
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Affiliation(s)
- Sandra Petzold
- Institute of Anatomy, Medical Faculty, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (S.P.); (K.F.)
| | - Silke Diana Storsberg
- Institute for Anatomy and Clinical Morphology, School of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany;
| | - Karin Fischer
- Institute of Anatomy, Medical Faculty, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (S.P.); (K.F.)
| | - Sven Schumann
- University Medical Center, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University, 55131 Mainz, Germany
- Correspondence:
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11
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Feng W, Zong Y, Zhao J, Li W, Miao Y, Xu Z, Xu Z, Sun J, Zheng M, Lu A. High versus low ligation of the inferior mesenteric artery during laparoscopic rectal cancer surgery: A prospective study of surgical and oncological outcomes. J Surg Oncol 2021; 123 Suppl 1:S76-S80. [PMID: 33651908 DOI: 10.1002/jso.26362] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES There is controversy regarding whether the inferior mesenteric artery (IMA) should be ligated at its origin from the aorta (high ligation, HL) or below the branch of the left colic artery (low ligation, LL) during surgery for rectal cancer. METHODS This prospective study randomized 95 patients with histologically proven rectal cancer (clinical stages I-III based on the 8th American Joint Committee on Cancer guidelines) to undergo HL (n = 47) or LL with lymph node dissection at the root of the IMA (n = 48). RESULTS Only two intraoperative adverse events were observed (two HL patients experienced anastomotic ischemia and underwent extended bowel excision and splenic flexure mobilization). The LL group had a significantly shorter time to first flatus (p < .0001). No significant differences were observed in operative time (p = .14), intraoperative blood loss (p = .21), distance from the upper margin (p = .77), distance from the lower margin (p = .35), harvested lymph nodes (p = .33), or anastomotic leakage (p = .44), 2-year overall survival (p = .97), or 2-year disease-free survival (p = .42). CONCLUSION During laparoscopic low anterior resection, a combination of LL at the IMA and vascular root lymph node dissection may help protect the blood supply of the anastomosis, reduce postoperative complications, and enhance recovery, without compromising radical excision.
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Affiliation(s)
- Wenqing Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Yaping Zong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Jingkun Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Wenchang Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Yiming Miao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Zifeng Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Zhuoqing Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Aiguo Lu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
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12
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Tang X, Zhang M, Wang C, He Q, Sun G, Qu H. Preservation of the left colic artery and superior rectal artery in laparoscopic surgery can reduce anastomotic leakage in sigmoid colon cancer. J Minim Access Surg 2021; 17:208-212. [PMID: 32964883 PMCID: PMC8083730 DOI: 10.4103/jmas.jmas_15_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The aim was to study the clinical significance in the preservation of the left colic artery (LCA) and superior rectal artery (SRA) for the laparoscopic resection of sigmoid colon cancer (SCC). Patients and Methods A total of 316 patients with SCC were divided into two groups. Group A received D3 resection with preservation of LCA and SRA, whereas Group B ligatured artery at the root of the inferior mesenteric artery. The operation time, number of resected lymph nodes, blood loss and anastomotic leakage rate were compared. Results In Group A, the average operation time was 283.02 ± 51.48 min, the average blood loss was 111.81 ± 77.08 ml and the average lymph node dissection was 14.8 ± 7.7. There was no statistical significance in blood loss and number of resected lymph nodes between Group A and B (P > 0.05). Longer operating time were observed in Group A as compared to Group B (P < 0.05). The anastomotic leakage rate had statistical significance between these two groups (P < 0.05). Conclusions Preservation of LCA and SRA was safe and feasible for the laparoscopic surgery of SCC, which could reduce anastomotic leakage rate.
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Affiliation(s)
- Xiaolong Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mengjun Zhang
- Department of General Surgery, Lanling People's Hospital, Linyi, China
| | - Chao Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Guorui Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Qu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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Shaibu Z, Chen ZH, Theophilus A, Mzee SAS. 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. Am Surg 2020; 87:1956-1964. [PMID: 33382355 DOI: 10.1177/0003134820983188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Zakari Shaibu
- Department of Gastrointestinal Surgery, 12676Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.,School of Medicine, 12676Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhi-Hong Chen
- Department of Gastrointestinal Surgery, 12676Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Acquah Theophilus
- Department of Gastrointestinal Surgery, 12676Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.,School of Medicine, 12676Jiangsu University, Zhenjiang, Jiangsu, China
| | - Said A S Mzee
- School of Medicine, 12676Jiangsu University, Zhenjiang, Jiangsu, China.,Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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14
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Balcerzak A, Kwaśniewska O, Podgórski M, Olewnik Ł, Polguj M. Types of inferior mesenteric artery: a proposal for a new classification. Folia Morphol (Warsz) 2020; 80:827-838. [PMID: 32964409 DOI: 10.5603/fm.a2020.0115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The inferior mesenteric artery (IMA) is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the anal canal. The aim of this study was to characterize the course and morphology of the terminal branches of the IMA, and also creating a new IMA classification, which seems to be necessary for clinicians performing surgery in this area. MATERIALS AND METHODS The anatomical variations in the branching patterns of the inferior mesenteric artery were examined in 40 cadavers fixed in a 10% formalin solution. Morphometric measurements were then obtained twice by two researchers. RESULTS Due to the proposed classification system, Type I characterized by a common trunk preceding bifurcation into sigmoidal branches and the superior rectal artery after giving LCA - Left Colic Artery occurred in 57.5% of cases, Type II, Trifurcation Type, in 25%, Type III with the superior rectal arteries originating firstly from the IMA in 5%, Type IV with the ascending lumbar artery in 10% of cases and Type V, a novelty, in 2.5%. The origin of IMA was observed at the level of L2/L3 in 22.5% of cases, at L3 in 25% of cases, at L3/L4 in 15% of cases, at L4 in 35% of cases and at the level of L5 in 2.5% of cases. More than one third (38.1%) of total cases with additional arteries and rapidly bifurcating branches occurred in Type III, IV, and V. In women only, the IMA and LCA were significantly narrower than in men. Only the diameter of the IMA correlated with the diameter of the superior rectal artery. CONCLUSIONS The IMA is characterized by high morphological variability. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.
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15
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Sakamoto W, Yamada L, Suzuki O, Kikuchi T, Okayama H, Endo H, Fujita S, Saito M, Momma T, Saze Z, Ohki S, Kono K. Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery. J Anus Rectum Colon 2019; 3:167-174. [PMID: 31768467 PMCID: PMC6845289 DOI: 10.23922/jarc.2019-016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
Objectives: Left colic artery preserving lymph node dissection around the inferior mesenteric artery (IMA) is a standard procedure for rectal cancer surgery. Although the IMA sheath is a well-known structure, to our knowledge, there are no reports describing its microanatomy from an oncological point of view; therefore, there is no consensus on how to handle the sheath for accurate lymph node dissection around IMA. We aimed to investigate the components of the IMA sheath pathologically, focusing particularly on the presence of lymph nodes (LNs) and lymphatic ducts (LDs). Methods: We evaluated rectal and sigmoid cancer specimens resected with high-tie technique in our institute in April 2017-April 2018. The specimens were collected consecutively, without any selection. In the resected specimens, the entire anatomical structure of IMA was investigated. We defined the IMA sheath as the tissues located between the surface of the IMA adventitia and collagenous layers connecting the outermost nerve fibers. The microanatomy around the IMA was examined using H&E staining, and LDs were identified using D2-40 immunohistochemistry. Results: Twenty patients were enrolled. No LNs were observed within the sheath in any of the cases. However, there were a significant number of LDs (11.08 ± 3.35) within the sheath. Conclusions: Our anatomical definition of IMA sheath was feasible and objectively possible. These microanatomical results partially support the surgical concept of left colic artery preserving lymph node dissection around the IMA. It may be difficult to remove all lymphatic ducts without removing the IMA itself.
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Affiliation(s)
- Wataru Sakamoto
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Leo Yamada
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Osamu Suzuki
- Department of Diagnostic Pathology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Kikuchi
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hirokazu Okayama
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hisahito Endo
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shotaro Fujita
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Motonobu Saito
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomoyuki Momma
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Zenichiro Saze
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinji Ohki
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
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16
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Yang X, Ma P, Zhang X, Wei M, He Y, Gu C, Deng X, Wang Z. Preservation versus non-preservation of left colic artery in colorectal cancer surgery: An updated systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e13720. [PMID: 30702552 PMCID: PMC6380791 DOI: 10.1097/md.0000000000013720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It remains unclear whether or not preservation of the left colic artery (LCA) for colorectal cancer surgery. The objective of this updated systematic review and meta-analysis is to evaluate the current scientific evidence of LCA non-preservation versus LCA preservation in colorectal cancer surgery. METHODS A systematic search was conducted in the Medline, Embase, PubMed, Cochrane Library, ClinicalTrials, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature Database, and reference without limits. Quality of studies was evaluated by using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for assessing the risk of bias. Effective sizes were pooled under a random- or fixed-effects model. The funnel plot was used to assess the publication bias. The outcomes of interest were oncologic consideration including the number of apical lymph nodes, overall recurrence, 5-years overall survival, and 5-years disease-free survival (DFS); safety consideration including overall 30-day postoperative morbidity and overall 30-day postoperative mortality; anatomic consideration including anastomotic circulation, anastomotic leakage, urogenital, and defaecatory dysfunction. RESULTS Twenty-four studies including 4 randomized controlled trials (RCTs) and 20 cohort studies with a total of 8456 patients (4058 patients underwent LCA non-preservation surgery vs 4398 patients underwent LCA preservation surgery) were enrolled in this meta-analysis. The preservation of LCA was associated with significantly less anastomotic leakage (odds ratio 1.23, 95% confidence interval 1.02-1.48, P = .03). In term of sexual dysfunction, urinary retention, the number of apical lymph nodes, and long-term oncologic outcomes, there were no significant differences between the LCA non-preservation and LCA preservation group. It was hard to draw definitive conclusions on other outcomes including operation time, blood loss, the first postoperative exhaust time, and perioperative morbidity and mortality for insufficient data and highly significant heterogeneity among studies. CONCLUSIONS The pooled data provided evidence to support the LCA preservation preferred over LCA non-preservation in anastomotic leakage. Future more large-volume, well-designed RCTs with extensive follow-up are needed to draw a definitive conclusion on this dilemma.
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Affiliation(s)
- Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Pingfan Ma
- State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University,Chengdu, China
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Yazhou He
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
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17
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Fan D, Zhang C, Li X, Yao C, Yao T. Evaluation of the clinical efficacy of preserving the left colic artery in laparoscopic resection for rectal cancer: A meta-analysis. Mol Clin Oncol 2018; 9:553-560. [PMID: 30345051 DOI: 10.3892/mco.2018.1714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/31/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of the present meta-analysis compared left colic artery (LCA) preservation with non-preservation in laparoscopic resection of rectal cancer in terms of feasibility, efficacy and safety. The PubMed, Ovid, Embase, Web of Science, CBM, CNKI, VIP and WanFang Data databases were searched prior to June 2017 for studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer. Two researchers screened the literature independently, extracted the data and evaluated the risk of bias. The study was performed using RevMan 5.3 software for meta-analysis. A total of 10 studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer were selected for this meta-analysis, with a combined study population of 1,471 patients. The results of the meta-analysis demonstrated that, when comparing LCA preservation with non-preservation in laparoscopic resection for rectal cancer, there were significant differences between the two groups in terms of operative time (P<0.01), estimated blood loss (P<0.01), percentage of neostomy (P<0.01), the number of retrieved lymph nodes (P<0.01), time to first postoperative exhaust (P<0.01) and amount of anastomotic leakage (P<0.01). However, there were no significant differences in postoperative hospital stay (P=0.28), incidence of recurrence (P=0.73) and incidence of metastasis (P=0.52). Therefore, compared with LCA non-preservation, patients in whom the LCA was preserved during laparoscopic resection for rectal cancer had a better prognosis. However, there was no difference in recurrence or metastasis between the two groups. Although the operative time and estimated blood loss were increased with LCA preservation, these may be reduced with improving proficiency of the operating surgeons. The conclusions of the present study require verification by larger samples and high-quality randomized controlled trials.
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Affiliation(s)
- Dongwei Fan
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Chensong Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Xuanhe Li
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Changyang Yao
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Tingjing Yao
- Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
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Abstract
RATIONALE Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published. PATIENT CONCERNS We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography. DIAGNOSIS Upper rectal intussusception caused by a giant rectal lipoma. INTERVENTIONS Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]). OUTCOMES The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit. LESSONS Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.
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Affiliation(s)
- Ran Wei
- The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Wei Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University
| | - Yuhong Xiao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University
| | - Fei Zeng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University
| | - Shengxun Mao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University
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Rutegård M, Hassmén N, Hemmingsson O, Haapamäki MM, Matthiessen P, Rutegård J. Anterior Resection for Rectal Cancer and Visceral Blood Flow: An Explorative Study. Scand J Surg 2015; 105:78-83. [PMID: 26250353 DOI: 10.1177/1457496915593692] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Impaired blood perfusion may be implicated in anastomotic leakage after anterior resection for rectal cancer. We investigated whether high ligation of the inferior mesenteric artery or total mesorectal excision compromises visceral blood flow in the colonic limb and the rectal stump, respectively. MATERIAL AND METHODS A prospective cohort study was conducted in a university hospital setting. We used Laser Doppler flowmetry to evaluate the impact of level of tie on colonic limb perfusion and the extent of the mesorectal excision on the rectal blood flow. In the rectum, different quadrants were also assessed. The Mann-Whitney U test was used to compare mean blood flow ratios between groups. RESULTS Some 23 patients were recruited in a convenience sample during a period in 2012-2013. The mean blood flow ratio was not decreased after high tie compared to low tie surgery (1.71 vs 1.19; p = 0.28). Total mesorectal excision reduced the mean blood flow ratio in the rectum, as compared with partial mesorectal excision (0.76 vs 1.28; p = 0.14). This was especially pronounced in the posterior aspect of the rectum (0.66 vs 1.68; p = 0.02). CONCLUSION High tie ligation did not seem to decrease colonic limb perfusion, while total mesorectal excision may decrease rectal blood flow. The posterior quadrant of the rectum might be particularly vulnerable to the dissection involved in total mesorectal excision.
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Affiliation(s)
- M Rutegård
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - N Hassmén
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - O Hemmingsson
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - M M Haapamäki
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - P Matthiessen
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - J Rutegård
- Department of Surgical and Perioperative Sciences, Umeå University Hospital, Umeå University, Umeå, Sweden
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Abstract
Vascular complications after percutaneous renal biopsy are uncommon and may require interventional management. In most of these cases, the pathology is a renal arterial pseudoaneurysm (PsA) or an arterio-venous fistula. Injury to other vessels like aorta, lumbar arteries or mesenteric arteries is rare with only one case of left colic artery PsA reported in literature. We report a case of a 60-year-old female, who developed left colic artery PsA after renal biopsy, which was successfully embolized through endovascular route using microcoils.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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