Level of Inferior Mesenteric Artery Ligation in Sigmoid Colon and Rectal Cancer Surgery: Analysis of Apical Lymph Node Metastasis and Recurrence.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-08-07 DOI:10.1159/000533407

Yuya Nakamura, Tadayoshi Yamaura, Yousuke Kinjo, Kazu Harada, Makoto Kawase, Yusuke Kawabata, Satoshi Kanto, Yasumasa Ogo, Nobukazu Kuroda

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引用次数: 0

Abstract

Introduction: Whether high or low ligation of the inferior mesenteric artery (IMA) is optimal for treating sigmoid colon and rectal cancers is controversial. The present study aimed to compare outcomes of high and low ligation of the IMA and determine the adequate extent of IMA lymph node dissection.

Methods: Subjects were 455 consecutive stage I-III colorectal cancer patients who underwent curative surgery between 2011 and 2019. We assessed the association between the level of IMA ligation and overall survival and recurrence-free survival (RFS) by propensity score matching analysis. Clinicopathological features of IMA lymph node metastasis and recurrence patterns were analyzed.

Results: After propensity score matching, the low ligation group had a significantly worse prognosis than that of the high ligation group for RFS (p = 0.039). Positive IMA lymph nodes were associated with pathological T3 or T4 stage and N2 stage. IMA lymph node recurrences in the high ligation group occurred at the superior left side of the IMA root. In contrast, all recurrences in the low ligation group occurred at the left colic artery bifurcation.

Conclusion: High ligation of IMA is oncologically safe. However, even with high ligation, care must be taken to ensure adequate lymph node dissection.

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乙状结肠和直肠癌症手术中肠下动脉结扎的水平：顶端淋巴结转移和复发的分析。

引言：高位还是低位结扎肠系膜下动脉（IMA）是治疗乙状结肠和直肠癌的最佳方法，一直存在争议。本研究旨在比较IMA高位和低位结扎的结果，并确定IMA淋巴结清扫的适当范围。方法：受试者为455名连续I-III期癌症患者，他们在2011年至2019年间接受了治疗性手术。我们通过倾向评分匹配分析评估了IMA结扎水平与总生存率和无复发生存率（RFS）之间的相关性。分析IMA淋巴结转移和复发的临床病理特点。结果：在倾向评分匹配后，低结扎组的RFS预后明显低于高结扎组（p=0.039）。IMA阳性淋巴结与病理学T3或T4期和N2期有关。高位结扎组的IMA淋巴结复发发生在IMA根的左上侧。相反，低结扎组的所有复发均发生在左绞痛动脉分叉处。结论：IMA高位结扎在肿瘤上是安全的。然而，即使进行高度结扎，也必须小心确保充分的淋巴结清扫。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.