Advertisement

International Journal of Colorectal Disease

, Volume 22, Issue 6, pp 689–697 | Cite as

Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery

  • Kazuhiro Seike
  • Keiji Koda
  • Norio Saito
  • Kenji Oda
  • Chihiro Kosugi
  • Kimio Shimizu
  • Masaru Miyazaki
Original Article

Abstract

Aims

The aim of this study is to evaluate the influence of dividing the inferior mesenteric artery (IMA) and preserving the left colic artery (LCA) on rectosigmoid cancer surgery.

Patients and methods

Colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in 96 patients with cancer of the rectum and sigmoid colon while clamping IMA or LCA. Results were analyzed with patient characteristics and postoperative complications.

Results

Blood flow was significantly decreased by either IMA or LCA clamping, and its reduction rate was 38.5 ± 1.8%, ranged from 0 to 82.8%, or 16.4 ± 1.8%, ranged from 0 to 66.2%, respectively. For multivariate analyses, aging and male gender were predictive factors of high blood flow reduction by IMA clamping. The reduction rate was significantly correlated with aging in male patients, while no such correlation was observed in women. Aging correlation in men was more significant in ultralow anterior resection cases. Three elderly male patients received IMA high ligation among 19 patients who demonstrated more than 50% blood flow reduction by IMA clamping. Among these, two patients, those who underwent ultralow anterior resection, suffered severe anastomotic ischemia.

Conclusions

Colonic blood flow at the proximal site of the anastomosis was significantly decreased by either IMA or LCA clamping. Patients with high reduction by IMA clamping need intraoperative efforts to prevent anastomotic ischemia, particularly in elderly male patients who undergo ultralow anterior resection.

Keywords

Laser Doppler flowmetry Inferior mesenteric artery Colorectal surgery Anastomosis Ischemia 

References

  1. 1.
    Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268PubMedCrossRefGoogle Scholar
  2. 2.
    Folkesson J, Nilsson J, Pahlman L et al (2004) The circular stapling device as a risk factor for anastomotic leakage. Colorectal Dis 6:275–279PubMedCrossRefGoogle Scholar
  3. 3.
    Staib L, Link KH, Blatz A et al (2002) Surgery of colorectal cancer: Surgical morbidity and five- and ten-year results in 2400 patients—monoinstitutional experience. World J Surg 26:59–66PubMedCrossRefGoogle Scholar
  4. 4.
    Bokey EL, Chapuis PH, Fung C et al (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–486PubMedCrossRefGoogle Scholar
  5. 5.
    Tiret E, Poupardin B, McNamara D et al (2003) Ultralow anterior resection with intersphincteric dissection—what is the limit of safe sphincter preservation? Colorectal Dis 5:454–457PubMedCrossRefGoogle Scholar
  6. 6.
    Ahn H, Lindhagen J, Nilsson GE et al (1985) Evaluation of laser Doppler flowmetry in the assessment of intestinal blood flow in the cat. Gastroenterology 88:951–957PubMedGoogle Scholar
  7. 7.
    Ahn H, Lindhagen J, Lundgren O (1986) Measurement of colonic blood flow with laser Doppler flowmetry. Scand J Gastroenterol 21:871–880PubMedGoogle Scholar
  8. 8.
    Koda K, Saito N, Oda K et al (2003) Natural killer cell activity and distant metastasis in rectal cancers treated surgically with and without neoadjuvant chemoradiotherapy. J Am Coll Surg 197:254–260PubMedCrossRefGoogle Scholar
  9. 9.
    Dworkin MJ, Allen-Mersh TG (1996) Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg 183:357–360PubMedGoogle Scholar
  10. 10.
    Hallböök O, Johansson K, Sjödahl R (1996) Laser Doppler blood flow measurement in rectal resection for carcinoma—comparison between the straight and colonic J pouch reconstruction. Br J Surg 83:389–392PubMedCrossRefGoogle Scholar
  11. 11.
    Vignali A, Gianotti L, Braga M et al (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82PubMedCrossRefGoogle Scholar
  12. 12.
    Pierie JP, de Graaf PW, Poen H et al (1994) Impaired healing of oesophagogastrostomies can be predicted by estimation of gastric serosal blood perfusion by laser Doppler flowmetry. Eur J Surg 160:599–603PubMedGoogle Scholar
  13. 13.
    Ikeda Y, Tobari S, Niimi M et al (2003) Reliable cervical anastomosis through the retrosternal route with stepwise gastric tube. J Thorac Cardiovasc Surg 125:1306–1312PubMedCrossRefGoogle Scholar
  14. 14.
    Inui K, Wada H, Yokomise H et al (1990) Evaluation of a bronchial anastomosis by laser Doppler velocimetry. J Thorac Cardiovasc Surg 99:614–619PubMedGoogle Scholar
  15. 15.
    Johansson K, Ahn H, Lindhagen J et al (1988) Effect of epidural anesthesia on intestinal blood flow. Br J Surg 75:73–76PubMedCrossRefGoogle Scholar
  16. 16.
    Sala C, Garcia-Granero E, Molina MJ et al (1997) Effect of epidural anesthesia on colorectal anastomosis: a tonometric assessment. Dis Colon Rectum 40:958–961PubMedCrossRefGoogle Scholar
  17. 17.
    Surtees P, Ritchie JK, Phillips RKS (1990) High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 7:618–621CrossRefGoogle Scholar
  18. 18.
    Pezim ME, Nicholls RJ (1984) Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 200:729–733PubMedCrossRefGoogle Scholar
  19. 19.
    Corder AP, Karanjia ND, Williams JD et al (1992) Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg 79:680–682PubMedCrossRefGoogle Scholar
  20. 20.
    Devries S, Wolfkiel C, Fusman B et al (1995) Influence of age and gender on presence of coronary calcium detected by ultrafast computed tomography. J Am Coll Cardiol 25:76–82PubMedCrossRefGoogle Scholar
  21. 21.
    Sonesson B, Hansen F, Stale H et al (1993) Compliance and diameter in the human abdominal aorta—the influence of age and sex. Eur J Vasc Surg 6:690–697CrossRefGoogle Scholar
  22. 22.
    Stensland-Bugge E, Bønna KH, Joakimsen O et al (2001) Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromsø study. Atherosclerosis 154:437–448PubMedCrossRefGoogle Scholar
  23. 23.
    Celermajer DS, Sorensen KE, Spiegelhalter DJ et al (1994) Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol 24:471–476PubMedCrossRefGoogle Scholar
  24. 24.
    Sudeck P (1907) Ueber die Gefässversorgung des Mastdarmes in Hinsicht auf die operative Gangrän. Muenchen Med Wschr 54:1314–1317Google Scholar
  25. 25.
    Yamazaki T, Shirai Y, Sakai Y et al (1997) Ischemic stricture of the rectosigmoid colon caused by division of the superior rectal artery below Sudeck’s point during sigmoidectomy: report of a case. Surg Today 27:254–256PubMedCrossRefGoogle Scholar
  26. 26.
    Milsom JW, Senagore A, Walshaw RK et al (1992) Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow. J Surg Res 53:464–469PubMedCrossRefGoogle Scholar
  27. 27.
    Friedmann P, Garb JL, McCabe DP et al (1987) Intestinal anastomosis after preoperative radiation therapy for carcinoma of the rectum. Surg Gynecol Obstet 164:257–260PubMedGoogle Scholar
  28. 28.
    Kapiteijn E, Kranenbarg EK, Steup WH et al (1999) Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Prospective randomised trial with standard operative and histopathological techniques. Dutch ColoRectal Cancer Group. Eur J Surg 165:410–420PubMedCrossRefGoogle Scholar
  29. 29.
    Novell JR, Lewis AAM (1990) Peroperative observation of marginal artery bleeding: a predictor of anastomotic leakage. Br J Surg 77:137–138PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Kazuhiro Seike
    • 1
  • Keiji Koda
    • 1
  • Norio Saito
    • 2
  • Kenji Oda
    • 1
  • Chihiro Kosugi
    • 1
  • Kimio Shimizu
    • 1
  • Masaru Miyazaki
    • 1
  1. 1.Department of General Surgery, Graduate School of MedicineChiba UniversityChibaJapan
  2. 2.Colorectal Surgery Division, The Department of Surgical OncologyNational Cancer Centre, Hospital East, KashiwaChibaJapan

Personalised recommendations