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Association of high ligation versus low ligation of the inferior mesenteric artery on anastomotic leak, postoperative complications, and mortality after minimally invasive surgery for distal sigmoid and rectal cancer

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

In the treatment of distal sigmoid and rectal cancer, the appropriate level for the ligation of the inferior mesenteric artery (IMA) remains unresolved. High ligation divides the IMA proximally at its origin, and low ligation ligates the IMA distal to the origin of left colic artery. We assessed the association of level of ligation in scheduled minimally invasive resection of sigmoid and rectal cancers on anastomotic leak, postoperative complications, and death within 30 days.

Methods

We identified all patients with primary sigmoid and rectal cancer treated with scheduled minimally invasive resection and primary anastomosis between January 2002 and June 2018 using linked institutional and National Surgical Quality Improvement Program databases. We assessed the association of level of ligation with each outcome by fitting individual univariable and multivariable logistic regression models, adjusting for surgical approach, tumor location, neoadjuvant chemoradiotherapy, and Charlson comorbidity index.

Results

We included 158 patients treated with high ligation and 123 patients treated with low ligation. Overall, 12 patients had an anastomotic leak requiring intervention within 30 days: 5 in the high ligation group (3.2%, 95% CI 1.4–7.2%) and 7 in the low ligation group (5.7%, 95% CI 2.8–11.3%). There was no association between the level of ligation and anastomotic leak (unadjusted OR 1.85, 95% CI 0.58–6.38; adjusted OR 0.63, 95% CI 0.16–2.55). Similarly, there was no association between the level of ligation and reoperation for anastomotic leak (OR 1.29, 95% CI 0.15–10.9), major complications (Clavien-Dindo III–V; OR 2.22, 95% CI 0.90–5.77), minor complications (Clavien-Dindo I–II; OR 1.51, 95% CI 0.88–2.60), and all complications (OR 1.58, 95% CI 0.94–2.67). No deaths occurred in either group.

Conclusions

There was no association of level of ligation of the IMA with anastomotic leak, postoperative complications as a composite, or death. The choice of high or low ligation of the IMA should be made based on technical factors such as length for the creation of a tension-free anastomosis.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Arman Draginov, Tyler R. Chesney, Sami A. Chadi & Fayez A. Quereshy

  2. Division of General Surgery, University Health Network, Toronto, ON, Canada

    Tyler R. Chesney, Sami A. Chadi & Fayez A. Quereshy

  3. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Humzah A. Quereshy

  4. Division of General Surgery and Surgical Oncology, University Health Network, Toronto Western Hospital, Main Pavilion 8-320, 399 Bathurst Street, Toronto, ON, M5T2S8, Canada

    Fayez A. Quereshy

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  1. Arman Draginov
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  2. Tyler R. Chesney
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Correspondence to Fayez A. Quereshy.

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Drs. Arman Draginov, Tyler R. Chesney, Humzah A. Quereshy, Sami A. Chadi, and Fayez A. Quereshy have no conflicts of interest or financial disclosures.

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Draginov, A., Chesney, T.R., Quereshy, H.A. et al. Association of high ligation versus low ligation of the inferior mesenteric artery on anastomotic leak, postoperative complications, and mortality after minimally invasive surgery for distal sigmoid and rectal cancer. Surg Endosc 34, 4593–4600 (2020). https://doi.org/10.1007/s00464-019-07203-0

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  • DOI: https://doi.org/10.1007/s00464-019-07203-0

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