However, the studies have been heterogeneous in terms of tumor location, cancer stage, and surgery type. Several meta-analyses have compared low and high ligations for superiority in reducing surgical complications and non-inferiority in oncologic outcomes ( 2– 4). Furthermore, the autonomic nerve plexus is potentially vulnerable during HL and may delay recovery of bowel function and subsequently impair genitourinary function. The benefit of HL in lowering recurrence and prolonging survival was also challenged because the lymph node metastasis rate of the IMA root was relatively low ( 1). These are particularly common in patients with vascular disease, obesity, or an advanced age with comorbidities. However, high ligation of the IMA (HL) theoretically compromises blood supply to the anastomosis due to removal of the left colic artery (LCA) and raises the concern of increasing the risk of related complications, including bowel ischemia, anastomotic leakage (AL), and anastomosis stenosis. Surgeons believe that high ligation improves lymph node yield (leading to accurate staging and better prognosis) and complete mobilization to release anastomotic tension. Whether high or low ligation of the inferior mesenteric artery (IMA) is optimal for rectal and sigmoid colon cancers is controversial. Furthermore, a secure anastomosis is crucial for good surgical results, and blood supply at the anastomotic site and tension-free anastomosis are particularly essential to prevent anastomotic insufficiency. Systematic Review Registration:, identifier 202190029.įor the optimal surgical treatment of sigmoid colon and rectal cancers, surgeons should accomplish the following: total mesorectal excision, R0 resection, adequate lymph node harvest, adequate distal resection margin (DRM), and negative circumferential resection margin involvement. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique. LL+HD was associated with low incidence of anastomotic leakage ( p < 0.001), borderline long operative time ( p = 0.06), and less yields of total lymph nodes ( p = 0.03) but equivalent IMA root lymph nodes ( p = 0.07) moreover, LL+HD exhibited non-inferior long-term oncological outcomes.Ĭonclusion: In comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers.
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In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). Results: A total of 17 studies, including four randomized controlled trials, published between 20 were selected.
#HEPATIC FLEXTURE RESECTION SOFTWARE#
Statistical analysis was performed using the statistical software RevMan version 5.4. The patient’s perioperative and oncologic outcomes were analyzed. Methods: PubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. 8Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwanīackground: Whether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial.7Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.6Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.5Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.4Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.3Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.2Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.1Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Tzu-Chieh Yin 1,2,3, Yen-Cheng Chen 3,4, Wei-Chih Su 3,4, Po-Jung Chen 3, Tsung-Kun Chang 3, Ching-Wen Huang 3,5, Hsiang-Lin Tsai 3,5* and Jaw-Yuan Wang 3,4,5,6,7,8*
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