Preservation of left colic artery with lymph node dissection of IMA root during laparoscopic surgery for rectosigmoid cancer. Results of a retrospective analysis

doi: 10.7417/CT.2019.2121

  • D. Crocetti Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • G. Cavallaro Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • M.R. Tarallo Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • A. Chiappini Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • A. Polistena Department of Surgical and Biomedical Sciences, University of Perugia, Italy
  • P. Sapienza Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • E. Fiori Department of Surgery “P. Valdoni”, Sapienza University, Rome
  • G. De Toma Department of Surgery “P. Valdoni”, Sapienza University, Rome

Abstract

Background
During sigmoid or rectal cancer surgery, dissection of lymph-nodes at the origin of inferior mesenteric artery is mandatory. Nevertheless, ligation of the origin of IMA should compromise blood supply to left colon and affect anastomosis. The aim of this retrospective evaluation is to compare high IMA ligation and low IMA ligation with preservation of LCA and skeletonization of the origin of IMA during laparoscopic colorectal resection.


Methods
All 120 patients included were affected by clinically M-0 sigmoid or rectal cancer. A laparoscopic colorectal resection with low or high ligature of IMA was performed. Low ligation was carried out with lymphadenectomy of the arterial root. Patients were divided in 2 groups according to type of treatment: Group A, high IMA ligation (N=65), Group B, low ligation with lymphadenectomy of IMA root (N=55).


Rusults
Preoperatively 59 patients had stage I, 42 patients had stage II  and 19 patients had stage III tumor. A mean of 20.3 +/- 4.5 lymph nodes were removed in group A patients and 18.9 +/- 9.1 in group B patients, and this difference was not statistically significant. Operative time, intraoperative and postoperative complication rates were not different between the two groups.


Conclusion
Low IMA ligation combined with lymph-node dissection at its origin is safe and effective, not time consuming and not associated to increased risk of complications and nerve damage. This technique can be considered as alternative to standard high IMA ligation in selected patients

Published
2019-04-16
How to Cite
CROCETTI, D. et al. Preservation of left colic artery with lymph node dissection of IMA root during laparoscopic surgery for rectosigmoid cancer. Results of a retrospective analysis. La Clinica Terapeutica, [S.l.], v. 170, n. 2, p. e124 - e128, apr. 2019. ISSN 1972-6007. Available at: <http://www.clinicaterapeutica.it/ojs/index.php/ClinicaTerapeutica/article/view/382>. Date accessed: 18 june 2019.
Section
Research Article