Are there any surgical and radiological correlations to the level of ligation of the inferior mesenteric artery after sigmoidectomy for cancer?

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• 作者：Flavien Prevot ; Charles Sabbagh ; Jean-Baptiste Deguines ; Arnaud Potier ; Cyril Cosse ; Thierry Yzet ; Jean-Marc Regimbeau
• 关键词：Inferior mesenteric artery ; Level of ligation ; Sigmoid cancer ; Sigmoidectomy
• 刊名：Annals of Anatomy - Anatomischer Anzeiger
• 出版年：October, 2013
• 年：2013
• 卷：195
• 期：5
• 页码：467-474
• 全文大小：1218 K

文摘

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Summary

Introduction

The Soci茅t茅 Fran莽aise de Chirurgie Digestive and the American Society of Colon and Rectal Surgeons recommend a ligation at the origin of the primary feeding vessel for sigmoid cancer to ensure optimal lymphadenectomy. We evaluated the correlation between the level of ligation defined by the surgeon and the real level of ligation visualized on postoperative CT scan.

Patients and methods

From December 2004 to August 2010, in a series of 146 patients undergoing colectomy for sigmoid cancer, 51 (19 women) CT measurements (visualization of the left colonic artery (LCA), length of the arterial stump) were performed by a radiologist blinded to operative data.

Results

This series comprised 63% of men with a mean age of 69 years. A correlation was demonstrated between the level of ligation assessed by the surgeon and the real level of ligation demonstrated on postoperative CT scan in 41% of cases. No risk factors for absence of correlation were identified (laparoscopy, gender, BMI, emergency, and ASA score). In the 鈥渘o correlation鈥?group, the site of ligation was overestimated in 70% of cases. No significant difference was observed between the 鈥渃orrelation鈥?and 鈥渘o correlation鈥?groups for lymphadenectomy (21.6 and 18 lymph nodes, p = 0.5593) or 5-year overall survival (71.4 and 93.1 months, p = 0.57).

Conclusion

In conclusion, the surgical and radiological correlations are low as the intraoperative estimation of the level of IMA ligation was correlated with CT findings in less than 50% of cases. No risk factors for non-correlation were identified, and there was no impact on lymphadenectomy. Overestimation of the level of ligation was the most frequent situation but did not appear to have any impact on tumor staging or on patient management in this group of patients.