Abstract
Aim
Curative surgery is the standard treatment for colorectal cancer. The ligation level of the inferior mesenteric artery (IMA) is still debated, as neither low tie (LT) nor high tie ligation (HT) has shown any benefit on the patients’ overall survival. We examined whether LT is standardizable and easily reproducible from an anatomical point of view.
Method
One hundred CT angiographies of healthy patients were analysed for the anatomy of the IMA and its division branches: left colic artery (LCA), sigmoid arteries trunk and superior rectal artery. Data analysed comprised angles between the IMA and the aorta, diameters of the IMA and its branches, repartition of the branches and distances between the origin of the branches and the origin of the IMA.
Results
IMA anatomy showed no variation. In contrast, its division branches showed important variability in terms of distance to the origin and repartition: in 19.9 % of the patients, the IMA directly splits into three branches, and in 17.6 % of the patients, the LCA originated at more than 5 cm from the origin of the IMA. These frequent variations led us to assume that the standardization of LT is very difficult in a context of neoplasm, where the quality of the lymphadenectomy is fundamental.
Conclusion
The division branches of the IMA are extremely subject to interindividual variations, making it difficult if not impossible to reproduce identically a surgical procedure based on their anatomy. HT appears to us as the only relevant procedure for colorectal cancer.
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References
Bonnet S, Berger A, Hentati N, Abid B, Chevallier JM, Wind P, Delmas V, Douard R (2012) High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum 55(5):515–521. doi:10.1097/DCR.0b013e318246f1a2
Cirocchi R, Trastulli S, Farinella E, Desiderio J, Vettoretto N, Parisi A, Boselli C, Noya G (2012) High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 21(3):e111–e123. doi:10.1016/j.suronc.2012.04.004
Colombo PE, Patani N, Bibeau F, Assenat E, Bertrand MM, Senesse P, Rouanet P (2011) Clinical impact of lymph node status in rectal cancer. Surg Oncol 20(4):e227–e233. doi:10.1016/j.suronc.2011.08.004
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(4):357–360
Grinnell RS (1965) Results of ligation of inferior mesenteric artery at the aorta in resections of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet 120:1031–1036
Hall NR, Finan PJ, Stephenson BM, Lowndes RH, Young HL (1995) High tie of the inferior mesenteric artery in distal colorectal resections–a safe vascular procedure. Int J Colorectal Dis 10(1):29–32
Hida J, Okuno K (2013) High ligation of the inferior mesenteric artery in rectal cancer surgery. Surg Today 43(1):8–19. doi:10.1007/s00595-012-0359-6
Hohenberger P, Schlag P, Kretzschmar U, Herfarth C (1991) Regional mesenteric recurrence of colorectal cancer after anterior resection or left hemicolectomy: inadequate primary resection demonstrated by angiography of the remaining arterial supply. Int J Colorectal Dis 6(1):17–23
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11(4):354–364. doi:10.1111/j.1463-1318.2008.01735.x discussion 364–355
Kanemitsu Y, Hirai T, Komori K, Kato T (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93(5):609–615. doi:10.1002/bjs.5327
Kang J, Hur H, Min BS, Kim NK, Lee KY (2011) Prognostic impact of inferior mesenteric artery lymph node metastasis in colorectal cancer. Ann Surg Oncol 18(3):704–710. doi:10.1245/s10434-010-1291-x
Kim JC, Lee KH, Yu CS, Kim HC, Kim JR, Chang HM, Kim JH, Kim JS, Kim TW (2004) The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer. Eur J Surg Oncol 30(3):271–279. doi:10.1016/j.ejso.2003.12.002
Lange MM, Buunen M, van de Velde CJ, Lange JF (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 51(7):1139–1145. doi:10.1007/s10350-008-9328-y
Liakakos T (2011) High ligation of inferior mesenteric artery: a standard procedure for colorectal cancer? Ann Surg Oncol 18(Suppl 3):S240–S241. doi:10.1245/s10434-011-1883-0 author reply S242–243
Malassagne B, Valleur P, Serra J, Sarnacki S, Galian A, Hoang C, Hautefeuille P (1993) Relationship of apical lymph node involvement to survival in resected colon carcinoma. Dis Colon Rectum 36(7):645–653
Murphy J, Young-Fadok T (2013) Extended lymphadenectomy in colon cancer is debatable. World J Surg. doi:10.1007/s00268-013-2071-0
Rouffet F, Hay JM, Vacher B, Fingerhut A, Elhadad A, Flamant Y, Mathon C, Gainant A (1994) Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French association for surgical research. Dis Colon Rectum 37(7):651–659
Seike K, Koda K, Saito N, Oda K, Kosugi C, Shimizu K, Miyazaki M (2007) Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis 22(6):689–697. doi:10.1007/s00384-006-0221-7
Titu LV, Tweedle E, Rooney PS (2008) High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review. Dig Surg 25(2):148–157. doi:10.1159/000128172
Tsujinaka S, Kawamura YJ, Tan KY, Mizokami K, Sasaki J, Maeda T, Kuwahara Y, Konishi F, Lefor A (2012) Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg 101(1):21–25
West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278. doi:10.1200/JCO.2009.24.1448
Yi SQ, Li J, Terayama H, Naito M, Iimura A, Itoh M (2008) A rare case of inferior mesenteric artery arising from the superior mesenteric artery, with a review of the review of the literature. Surg Radiol Anat 30(2):159–165. doi:10.1007/s00276-007-0298-x
Zebrowski W, Augustyniak E, Zajac S (1971) Variations of origin and branching of the interior mesenteric artery and its anastomoses. Folia Morphol (Warsz) 30(4):575–583
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Bertrand, M.M., Delmond, L., Mazars, R. et al. Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches. Surg Radiol Anat 36, 1057–1062 (2014). https://doi.org/10.1007/s00276-014-1281-y
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DOI: https://doi.org/10.1007/s00276-014-1281-y