Annals of Coloproctology

Original Articles

Colorectal cancer

Long-term clinical outcomes after high and low ligations with lymph node dissection around the root of the inferior mesenteric artery in patients with rectal cancer: Min Wan Lee, Sung Sil Park, Kiho You, Dong Eun Lee, Dong Woon Lee, Sung Chan Park, Kyung Su Han, Dae Kyung Sohn, Chang Won Hong, Bun Kim, Byung Chang Kim, Hee Jin Chang, Dae Yong Kim, Jae Hwan Oh; Ann Coloproctol. 2024;40(1):62-73. Published online February 26, 2024; DOI: https://doi.org/10.3393/ac.2023.00094.0013

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Purpose
This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer.
Methods
This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires.
Results
In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group.
Conclusion
LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

Citations

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Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
Eun Jung Park
Science Editing.2025; 12(1): 66. CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef

Oncologic and Anastomotic Safety of Low Ligation of the Inferior Mesenteric Artery With Additional Lymph Node Retrieval: A Case-Control Study: Cho Shin Kim, Sohyun Kim; Ann Coloproctol. 2019;35(4):167-173. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.09

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Abstract PDF

Purpose
We assessed the oncologic and anastomotic benefits of low ligation of the inferior mesenteric artery (IMA) with additional lymph node (LN) retrieval.
Methods
We performed a retrospective case-control study between January 2011 and July 2015. All patients underwent curative resection of a primary sigmoid or rectal tumor. We excluded patients with distant metastases at the time of diagnosis. The case group included patients who underwent high ligation of the IMA (high group, HG). The control group included patients who underwent low ligation of the IMA with low group with additional LN retrieval (LGAL). Controls were identified by matching patients based on age (±5 years), sex, tumor location, and final histopathological stage. Finally, each group included 97 patients.
Results
Clinical characteristics did not significantly differ between groups. The mean number of additional harvested LN was 2.19 (range, 0–11), and one patient in the LGAL had a metastatic LN among the additional harvested LN. The overall morbidity was 22.7% in the HG and 30% in the LGAL (P = 0.257). Anastomotic leakage occurred in 14 patients (14.4%) in the HG and 5 patients (5.2%) in the LGAL (P = 0.030). The mean disease-free survival time in the HG was longer than that in the LGAL (P = 0.008). The mean overall survival (OS) time was 70.4 ± 1.3 months. The mean OS was 63.7 ± 1.6 months in the HG and 69.1 ± 2.6 months in the LGAL (P = 0.386).
Conclusion
Low ligation of the IMA with additional LN retrieval is technically safe. However, the oncologic effect was better after high ligation of IMA.

Citations

Citations to this article as recorded by

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Andrea Balla, Federica Saraceno, Anna Guida, Rosa Scaramuzzo, Diletta Corallino, Giuseppe Maria Ettorre, Pasquale Lepiane
Journal of Laparoendoscopic & Advanced Surgical Techniques.2023; 33(4): 397. CrossRef
Ligation level of inferior mesenteric artery in rectal cancer: a meta-analysis
Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef
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The significance of anatomical variation of the inferior mesenteric artery and its branches for laparoscopic radical resection of colorectal cancer: a review
Shun Zeng, Wenhao Wu, Xianbin Zhang, Tong Qiu, Peng Gong
World Journal of Surgical Oncology.2022;[Epub] CrossRef
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R. I. Fayzulin, M. A. Tarasov, A. A. Ponomarenko, S. V. Chernyshov, E. G. Rybakov
Koloproktologia.2022; 21(4): 10. CrossRef
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Yang Luo, Min-Hao Yu, Yi-Zhou Huang, Ran Jing, Jun Qin, Shao-Lan Qin, Jay N Shah, Ming Zhong
Cancer Management and Research.2021; Volume 13: 3963. CrossRef
Clinical Impact of Inferior Mesenteric Lymph Node Metastasis in Patients with Cancer of the Sigmoid Colon or Rectum
Rikiya Sato, Shuichiro Matoba, Hiroya Kuroyanagi, Masashi Ueno, Shigeo Toda, Yutaka Hanaoka, Kosuke Hiramatsu, Yusuke Maeda, Yuki Nishihara
Indian Journal of Surgical Oncology.2021; 12(4): 658. CrossRef
High Versus Low Ligation of the Inferior Mesenteric Artery During Rectal Resection for Cancer: Oncological Outcomes After Three Years of Follow-Up From the HIGHLOW Trial
Giulio M. Mari, Jacopo Crippa, Pietro Achilli, Isacco Montroni, Giampaolo Ugolini, Giovanni Taffurelli, Eugenio Cocozza, Giacomo Borroni, Francesco Valenti, Francesco Roscio, Giovanni Ferrari, Matteo Origi, Walter Zuliani, Raffaele Pugliese, Andrea T. M.
Annals of Surgery Open.2020; 1(2): e017. CrossRef

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