Controversy and consideration of high and low ligation of inferior mesenteric artery in radical resection of rectal cancer
10.3760/cma.j.cn112139-20200330-00266
- VernacularTitle:直肠癌根治术中肠系膜下动脉高位和低位结扎的争议与思考
- Author:
Zhanlong SHEN
1
;
Yudi BAO
;
Yingjiang YE
;
Shan WANG
Author Information
1. 北京大学人民医院胃肠外科 北京大学人民医院外科肿瘤研究室 北京市结直肠癌诊疗研究重点实验室 100044
- Keywords:
Rectal neoplasms;
Mesenteric artery, inferior;
Surgical procedures, operative;
Lymph node excision;
Anastomotic leakage
- From:
Chinese Journal of Surgery
2020;58(8):596-599
- CountryChina
- Language:Chinese
-
Abstract:
Radical resection is one of the most important treatment for rectal cancer, which requires not only removal of adequate bowel and mesorectum around the tumor, but also thorough lymphadenectomy. Besides, postoperative complications are surgeons′ concerns as well. According to different ways to manage inferior mesenteric artery, procedures could be divided into two groups: inferior mesenteric artery (IMA) high ligation and low ligation, which lead to various outcomes of the extent of lymph nodes dissection, survival, preservation of intestinal blood supply, incidence of anastomotic leakage, and postoperative functions including defecation function, urinary function and sexual function. Author believes that for those patients with clinical stage T1, low ligation and D2 lymph nodes dissection could be considered. However, for patients with locally advanced carcinomas (clinical stage T2+or N+), especially suspicious metastasis of lymph nodes around IMA root, high ligation and D3 lymph node dissection is suggested to ensure en bloc resection. As for those patients with high risks for compromised intestinal blood supply, preservation of left colic artery plus D3 lymph nodes dissection might be a feasible way. Intraoperative indocyanine green fluorescent imaging might play a role in quality control of lymphadenectomy.
