Inferior mesenteric artery no. 253 lymph node dissection with preservation of the left colic artery: Controversies revisited

Abstract

Background

In radical resection for rectal cancer, the optimal dissection strategy for lymph nodes at the root of the inferior mesenteric artery (IMA, No. 253) remains a subject of intense debate. Traditional high ligation (HGL) facilitates comprehensive lymphatic clearance but risks compromising anastomotic blood supply and injuring pelvic autonomic nerves. While low ligation (LGL) with preservation of the left colic artery (LCA) aims to balance oncological radicality with functional preservation, its long-term safety and specific indications require further clarification.

Methods

This review systematically evaluates international paradigm shifts, recent anatomical insights, and existing evidence-based medical data regarding No. 253 lymph node dissection (LND). We analyzed the trade-offs between HGL and LGL-LCA techniques in terms of oncological outcomes, anastomotic complications, and postoperative quality of life.

Results

Current evidence suggests that LCA preservation may reduce the incidence of anastomotic leakage and defecatory dysfunction without compromising short-term oncological safety. However, the technical complexity and anatomical variations of the IMA region pose challenges for standardization. Based on this reappraisal, we propose a "Modular Zonal Dissection Strategy." This approach categorizes the IMA root into specific surgical zones, allowing for a structured and reproducible workflow that prioritizes both anatomical precision and surgical safety.

Conclusion

The proposed modular zonal dissection strategy provides a standardized framework for No. 253 LND with LCA preservation. By simplifying the surgical workflow and enhancing anatomical clarity, this strategy aims to achieve an optimal balance between radical oncological clearance and the protection of postoperative function in rectal cancer patients.