Ann Surg Treat Res.  2018 Apr;94(4):209-215. 10.4174/astr.2018.94.4.209.

Feasibility and oncologic safety of low ligation of inferior mesenteric artery with D3 dissection in cT3N0M0 sigmoid colon cancer

Affiliations
  • 1Department of Surgery, Chungnam National University Hospital, Daejeon, Korea. jkim@cnu.ac.kr

Abstract

PURPOSE
There is no standard consensus for the ligation level of the inferior mesenteric artery during radical resection of sigmoid colon cancer. Especially, there is little research about low ligation combined with D3 dissection. The study was performed to compare feasibility and oncologic safety between low ligation with D3 dissection to high ligation in intermediately advanced sigmoid colon cancer.
METHODS
From January 2008 to December 2013, 134 patients who underwent radical surgery for cT3N0M0 sigmoid colon cancer were evaluated retrospectively. Clinicopathologic factors and oncologic outcomes of high ligation (HL, n = 51) and low ligation (LL, n = 83) groups were compared.
RESULTS
The mean operative time was significantly shorter in LL, and there was no difference in complications, distal margin or number of retrieved lymph node. The tumor size was significantly larger in HL, but there was no difference in number of metastatic lymph node, pT or pN stage. There was no difference in overall survival, disease-free survival, or local and systemic recurrence.
CONCLUSION
In cT3N0M0 sigmoid colon cancers, we suggest that low ligation with D3 dissection can be performed with feasibility and oncological safety.

Keyword

Colon neoplasms; Inferior mesenteric artery; Lymph node excision; Feasibility studies; Survival

MeSH Terms

Colon, Sigmoid*
Colonic Neoplasms
Consensus
Disease-Free Survival
Feasibility Studies
Humans
Ligation*
Lymph Node Excision
Lymph Nodes
Mesenteric Artery, Inferior*
Operative Time
Recurrence
Retrospective Studies
Sigmoid Neoplasms*

Figure

  • Fig. 1 High ligation: ligation approximately 1 cm from the aortic origin of the artery with en bloc dissection of the inferior mesenteric lymph nodes as D3 dissection.

  • Fig. 2 Low ligation: ligation below the origin of the left colic artery with preservation of the left colic artery and additional D3 dissection from the root of the inferior mesenteric artery to the left colic artery.

  • Fig. 3 (A) Five-year overall survival (OS) of high and low ligation groups. (B) Five-year disease-free survival (DFS) of high and low ligation groups. (C) Five-year local recurrence (LR) of high and low ligation groups. (D) Five-year systemic recurrence (SR) of high and low ligation groups. HL, high ligation group; LL, low ligation group.


Cited by  1 articles

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients
Gyung Mo Son, Tae Un Kim, Byung-Soo Park, Hyuk Jae Jung, Sang Su Lee, Ji-Uk Yoon, Jun Woo Lee
Ann Surg Treat Res. 2019;97(2):74-82.    doi: 10.4174/astr.2019.97.2.74.


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