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High tie versus low tie of the inferior mesenteric artery in colorectal cancer

ABSTRACT: Interventions: A:low tie of IMA, preserve LCA;B:high tie of IMA, not preserve LCA Primary outcome(s): Operation time;The total of hemorrhages quantities;The time of break wind after the operation;The number and positive rate of IMA vascular root lymph node;disease rate after the operation Study Design: Randomized parallel controlled trial

DISEASE(S): Colorectal Cancer

PROVIDER: 2663924 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Anatomical Classifications of Inferior Mesenteric Artery

Project description:The vascular branches of inferior mesenteric artery (IMA) involve superior rectal artery(SRA),Sigmoid artery(SA) and the left colic artery(LCA). Different levels of ligation of the (IMA) are applied in rectal cancer surgery, including retain or not retain the left colic artery(LCA). Retained the LCA would facilitate the vascularity. The variations of vessels are more frequent in the combinations of branches, while LCA, SA and SRA may vary from people to people. Which contribute to the difficulty of surgery to retain the LCA.. As a result, a better understanding of the anatomical branches classification of IMA is a must during operation. However, existing studies of IMA’s branches combination are very rare and often single-centered with minimal samples. In order to achieve better surgical outcome and reduce operative complications, the investigators design this study to investigate the anatomical classification of IMA and the surgical outcome of each type

| 2272213 | ecrin-mdr-crc

Preoperative injection of nano-carbon suspension combined with surgical technique of lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery in patients with colorectal cancer undergoing NOSES( natural orifice specimen extraction)

Project description:Interventions: early group:Preserve blood vessels in the left colon;medium group:Preserve blood vessels in the left colon;late group:Preserve blood vessels in the left colon Primary outcome(s): the number of lymph nodes Study Design: Non randomized control

| 2682823 | ecrin-mdr-crc

A unique proposed etiology for inferior mesenteric artery aneurysm: A case report.

Project description:The etiology of large artery aneurysms has long been established as secondary to atherosclerotic disease and degenerative changes in the vessel walls. Less common, are aneurysms of the visceral arteries; the splanchnic and renal arteries. Rarer yet, are inferior mesenteric artery aneurysms, accounting for approximately 1% of visceral artery aneurysms. While causes range from inflammatory to congenital disease, a proposed etiology of proximal, solitary inferior mesenteric artery aneurysms, is correlated to the "jet disorder phenomenon," first described in a 1990 case report by Sugrue, and Hederman. This paradigm states that aneurysm formation may occur secondary to celiac and superior mesenteric artery occlusion, causing increased, and turbulent arterial flow distally. We present a case that demonstrates a small inferior mesenteric artery aneurysm without findings of celiac or superior mesenteric artery stenosis or occlusion. This patient did, however, have a large thrombosed common hepatic artery aneurysm which may serve as an alternate cause of jet disorder phenomenon. The findings in this case offers support for focused screening of proximal arterial vasculature when an inferior mesenteric artery aneurysm is encountered.

| S-EPMC9018125 | biostudies-literature

Dissection of the inferior mesenteric vein versus of the inferior mesenteric artery for the genitourinary function after laparoscopic approach of rectal cancer surgery: a randomized controlled trial.

Project description:BackgroundTotal Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA.MethodsProspective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group.DiscussionThe aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery.Trial registrationEthical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).

| S-EPMC6683580 | biostudies-literature

Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis.

Project description:Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.

| S-EPMC8873484 | biostudies-literature

Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery.

Project description:BackgroundThe level of inferior mesenteric artery (IMA) ligation for anterior resection of rectal cancer has several considerations concerning oncological outcomes. The primary endpoint of this randomized controlled trial (RCT) was to assess bowel function between high and low ligation. This study was intended to clarify oncological outcome as the secondary endpoint.ObjectiveThe aim of this study was to assess in a prospective RCT whether the ligation level of the IMA in rectal cancer influences oncological outcomes.MethodsBetween February 2008 and December 2011, 100 patients who underwent anterior resection for rectal cancer were randomized to perform either high or low ligation of the IMA. Oncological outcomes was the secondary endpoint of this RCT, whereas assessing bowel function was the primary endpoint. This RCT was registered at clinicaltrials.gov (NCT00701012).ResultsThere were no differences between the groups in terms of clinical data except for tumor stage. There were more advanced-stage patients in the high ligation group (p = 0.046). There were no lymph node (LN) metastases in the root of the IMA in the high ligation group. The average number of harvested LNs for the high and low ligation groups was 16.7 and 14.9, respectively. There was no difference in disease-free survival (DFS), site of first recurrence, and overall survival (OS). When patients were in stage III, there was also no difference in DFS and OS.ConclusionsThe ligation level of the IMA in rectal cancer may not influence oncological outcomes. However, further large-scale RCTs are needed to conclude this issue.

| S-EPMC5649244 | biostudies-literature

To go high, or to go low: the never-ending debate of inferior mesenteric artery ligation.

Project description: Not available

| S-EPMC10915534 | biostudies-literature

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer.

Project description:The optimal level for inferior mesenteric artery ligation during anterior resection for rectal cancer is controversial. The aim of this randomized trial was to clarify whether the inferior mesenteric artery should be tied at the origin (high tie) or distal to the left colic artery (low tie).Patients were allocated randomly to undergo either high- or low-tie ligation and were stratified by surgical approach (open or laparoscopic). The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were duration of surgery, blood loss and 5-year overall survival.Some 331 patients entered the trial between June 2006 and September 2012. The trial was stopped prematurely as recruitment was slow. Seven patients were excluded after randomization but before operation because of procedural changes. High tie and low tie were performed in 164 and 160 patients respectively. The incidence of anastomotic leakage was not significantly different (17·7 versus 16·3 per cent respectively; P = 0·731). The incidence of severe complications requiring intervention was 2·4 versus 5·0 per cent for high and low tie respectively (P = 0·222). In multivariable analysis, risk factors for anastomotic leakage included male sex (odds ratio 4·36, 95 per cent c.i. 1·56 to 12·18) and distance of the tumour from the anal verge (odds ratio 0·99, 0·98 to 1·00). At 5 years there were no significant differences in overall (87·2 versus 89·4 per cent respectively; P = 0·386) and disease-free (76·3 versus 77·6 per cent; P = 0·765) survival.The level of ligation of the inferior mesenteric artery does not significantly influence the rate of anastomotic leakage. Registration number: NCT01861678 ( https://clinicaltrials.gov).

| S-EPMC6069351 | biostudies-literature

Mesenteric occlusive disease of the inferior mesenteric artery is associated with anastomotic leak after left-sided colon and rectal cancer surgery: a retrospective cohort study.

Project description:PurposeAnastomotic leak (AL) is a serious complication following colorectal surgery. Atherosclerosis causes inadequate anastomotic perfusion and is suggested to be a risk factor for AL. The aim of this study was to investigate the association of mesenteric occlusive disease on preoperative computed tomography (CT) scan with AL after left-sided colon or rectal cancer surgery.MethodsThis was a retrospective, multicenter cohort study including 1273 patients that underwent left-sided or rectal cancer resection between 2009 and 2018 from three hospitals in the Netherlands. AL patients were 1:1 matched with non-leak patients and preoperative contrast-enhanced CT-scans were retrospectively analyzed for mesenteric atherosclerotic lesions. The main outcome measure was the presence of mesenteric occlusive disease on the preoperative CT-scan.ResultsAnastomotic leak developed in 6% of 1273 patients (N = 76). Low anterior resection and stage I-III disease were statistically significant associated with AL (p = 0.01, p = 0.04). No other statistically significant differences in patient characteristics between AL and non-leak patients were found. A clinically significant stenosis (≥ 70-100%) of the inferior mesenteric artery was statistically significant more frequent present in AL patients, compared to non-leak patients (p < 0.01). No statistically significant differences in the presence of mesenteric occlusive disease of the celiac artery and superior mesenteric artery between AL patients and non-leak patients were found.ConclusionMesenteric occlusive disease of the IMA on preoperative CT-scan is associated with AL after left-sided colon or rectal resection for cancer. Preoperative identification of high-risk patients with a preoperative CT-scan of the mesenteric vasculature might be useful to reduce the risk of AL.

| S-EPMC8885551 | biostudies-literature

A vascular typing study based on superior mesenteric artery and vein variations that can reflect the extent of right colon lymphatic drainage and evaluate the difficulty of surgery

Project description:Interventions: experimental group:SMA-guided lymph node dissection;control group:SMV-guided lymphatic dissection Primary outcome(s): Operation time;Amount of bleeding;Conversion rate of laparotomy;Number of lymph nodes obtained;First anal exhaust time;First time out of bed;Drainage flow of drainage tube;indwelling time of drainage tube;Incidence of postoperative short-term complications;Rate of re-hospitalization 30 days after surgery;Rate of mortality 30 days after surgery;Local recurrence rate;Median disease-free survival time;Median overall survival time Study Design: Case-Control study

| 40635 | ecrin-mdr-crc

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