Published online Aug 28, 2018. doi: 10.3748/wjg.v24.i32.3671
Peer-review started: July 2, 2018
First decision: July 11, 2018
Revised: July 17, 2018
Accepted: July 22, 2018
Article in press: July 21, 2018
Published online: August 28, 2018
Processing time: 61 Days and 22.7 Hours
In laparoscopic radical resection for rectal cancer, according to the location of the tie of the inferior mesenteric artery (IMA), it is divided into the high-tie of the IMA at its origin and the low-tie of the IMA below the branch into the left colic artery (LCA) with preservation of the LCA. Currently, there is still controversy regarding the indications for high-tie or low-tie approaches.
In laparoscopic radical resection for rectal cancer, high-tie of the IMA at its origin is essential for en bloc lymph node dissection. We studied the vascular anatomy of the IMA to safely and effectively dissect the lymph nodes around the IMA while preserving the LCA in a laparoscopic procedure for rectal cancer.
We aimed to investigate the vascular anatomy of IMA in laparoscopic radical resection with the preservation of LCA for rectal cancer.
The records of 110 patients, who underwent laparoscopic surgical resection with preservation of the LCA for rectal cancer from March 2016 to November 2017 were retrospectively analyzed. The research participants were recruited from the Department of General Surgery of Qilu Hospital, a teaching hospital of Shandong University in Shandong, China. A 3D vascular reconstruction was performed before each surgical procedure to assess the branches of the IMA. During surgery, the relationship among the IMA, LCA, sigmoid artery (SA) and superior rectal artery (SRA) was evaluated.
IMA, LCA, SA, and SRA were studied in 110 cases by preoperative 3D reconstruction of the vascular anatomy and laparoscopic surgery. Three vascular types were identified in the study: type A, LCA arose independently from the IMA (46.4%, n = 51); type B, LCA and SA branched from a common trunk of the IMA (23.6%, n = 26); and type C, LCA, SA, and SRA branched at the same location (30.0%, n = 33). There was no statistically significant difference in the length from the origin of the IMA to the LCA among the three types. In laparoscopic surgery, the LCA was located under the IMV in 61 cases and above the IMV in 49 cases. The ratio regarding the location of the LCA under the IMV in the three types was similar. The data of operating time, blood loss, and the length of postoperative hospital stay were not statistically significant among the three types. Additionally, there were no statistically significant differences in the dissected lymph node numbers. The incidence of metastasis to station 253 nodes was 4.5% (5 of 110). The postoperative complications included anastomotic bleeding in two cases and anastomotic leakage in two cases.
Knowledge of the anatomy of the branch vessels originating from the IMA and the relationship between the IMA and IMV are essential in order to conduct a laparoscopic radical resection with preservation of the LCA for rectal cancer. To recognize the different branches of the IMA is necessary for the resection of lymph nodes and dissection of vessels.
We studied the vascular anatomy of the IMA to safely and effectively dissect the lymph nodes around the IMA while preserving the LCA in a laparoscopic procedure for rectal cancer. However, in the light of the limited evidence, the clinical benefit needs more high-quality RCT studies.