Advertisement

Laparoscopic lymph node dissection around the inferior mesenteric artery for cancer in the lower sigmoid colon and rectum

Is D3 lymph node dissection with preservation of the left colic artery feasible?
  • M. Kobayashi
  • K. Okamoto
  • T. Namikawa
  • T. Okabayashi
  • K. Araki
Article

Abstract

Background

When we perform laparoscopic lymph node dissection around the inferior mesenteric artery (IMA), we preserve the left colic artery (LCA) to maintain the blood supply to the proximal sigmoid colon. In this study, we present our laparoscopic D2 and D3 lymph node (LN) dissection technique and evaluate its applicability and safety.

Methods

We performed LN dissection on 23 rectal and lower sigmoid colon cancer cases from April 2002 to December 2004. For D3 LN dissection, the incision to the mesosigmoid extends to just before the root of the IMA, which is exposed with an ultrasonic cutting and coagulating surgical device to avoid bleeding. Then, the arterial wall is exposed with a dissecting electrocautery spatula down to the LCA, at least 2 cm of which is exposed. Adipose tissue surrounding the IMA and inferior mesenteric vein is dissected. For D2 LN dissection, we partially expose the IMA to confirm the location of the LCA.

Results

The mean times taken for D2 and D3 LN dissections were 36.2 and 68.2 min, respectively. Both procedures took longer in male patients. There was a trend for the procedure overall to take less time in female patients. However, D2 dissection took significantly longer in male than female patients (p < 0.05). In women, D3 dissection took significantly longer than D2 (p < 0.05), but this trend was not seen in men. Increased experience among surgeons with this procedure was associated with significantly faster LN dissections in men (p < 0.05), but not in women (p = 0.493). Pearson product moment analysis identified a relationship between body mass index (BMI) and the time taken for D2 LN dissection (r = 0.765), but not D3 LN dissection (r = 0.158).

There was no treatment-related morbidity with this technique.

Conclusions

This method was safe and feasible for all patients in this series, but takes longer to perform in male patients.

Keywords

Laparoscopic assisted colectomy Lymph node dissection Inferior mesenteric artery Rectal cancer Colon cancer 

Notes

Acknowledgment

This study was supported by Kobayashi Magobe Memorial Medical Foundation.

References

  1. 1.
    Baixauli J, Kiran RP, Delaney CP (2003) Investigation and management of ischemic colitis. Cleveland Clin J Med 70: 920–934CrossRefGoogle Scholar
  2. 2.
    Griffiths JD (1956) Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg Engl 19: 241–256PubMedGoogle Scholar
  3. 3.
    Horton KM, Fishman EK (2000) 3D CT angiography of the celiac and superior mesenteric arteries with multidetector CT data sets: preliminary observations. Abdom Imaging 25: 523–525CrossRefPubMedGoogle Scholar
  4. 4.
    Kornblith PL, Boley SJ, Whitehouse BS (1992) Anatomy of the splanchnic circulation. Surg Clin North Am 72: 1–30PubMedGoogle Scholar
  5. 5.
    Milsom JW, Böhm B (1996) Laparoscopic colorectal surgery. Springer-Verlag, New York, pp 117–194Google Scholar
  6. 6.
    Milsom JW, Böhm B, Decanini C, Fazio VW (1994) Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model. Surg Endosc 8: 1117–1123CrossRefPubMedGoogle Scholar
  7. 7.
    Rosenblum JD, Boyle CM, Schwartz LB (1997) The mesenteric circulation: anatomy and physiology. Surg Clin North Am 77: 289–306CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • M. Kobayashi
    • 1
  • K. Okamoto
    • 1
  • T. Namikawa
    • 1
  • T. Okabayashi
    • 1
  • K. Araki
    • 1
  1. 1.Department of Tumor SurgeryKochi Medical SchoolNankokuJapan

Personalised recommendations