Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches

Aim Curative surgery is the standard treatment for colorectal cancer. The ligation level of the inferior mesenteric artery (IMA) is still debated, as neither low tie (LT) nor high tie ligation (HT) has shown any benefit on the patients’ overall survival. We examined whether LT is standardizable and...

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Bibliographic Details
Published in:Surgical and radiologic anatomy (English ed.) 2014-12, Vol.36 (10), p.1057-1062
Main Authors: Bertrand, M. M., Delmond, L., Mazars, R., Ripoche, J., Macri, F., Prudhomme, M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anatomy
Anatomy & physiology
Colorectal cancer
Colorectal Neoplasms
Colorectal surgery
Contrast Media - administration & dosage
Female
Humans
Image Processing, Computer-Assisted - methods
Imaging
Iopamidol - administration & dosage
Iopamidol - analogs & derivatives
Male
Medicine
Medicine & Public Health
Mesenteric Artery, Inferior - anatomy & histology
Mesenteric Artery, Inferior - diagnostic imaging
Middle Aged
Multidetector Computed Tomography - methods
Original Article
Orthopedics
Radiographic Image Enhancement - methods
Radiology
Reference Values
Reproducibility of Results
Retrospective Studies
Surgery
Veins & arteries
Young Adult
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Summary:Aim Curative surgery is the standard treatment for colorectal cancer. The ligation level of the inferior mesenteric artery (IMA) is still debated, as neither low tie (LT) nor high tie ligation (HT) has shown any benefit on the patients’ overall survival. We examined whether LT is standardizable and easily reproducible from an anatomical point of view. Method One hundred CT angiographies of healthy patients were analysed for the anatomy of the IMA and its division branches: left colic artery (LCA), sigmoid arteries trunk and superior rectal artery. Data analysed comprised angles between the IMA and the aorta, diameters of the IMA and its branches, repartition of the branches and distances between the origin of the branches and the origin of the IMA. Results IMA anatomy showed no variation. In contrast, its division branches showed important variability in terms of distance to the origin and repartition: in 19.9 % of the patients, the IMA directly splits into three branches, and in 17.6 % of the patients, the LCA originated at more than 5 cm from the origin of the IMA. These frequent variations led us to assume that the standardization of LT is very difficult in a context of neoplasm, where the quality of the lymphadenectomy is fundamental. Conclusion The division branches of the IMA are extremely subject to interindividual variations, making it difficult if not impossible to reproduce identically a surgical procedure based on their anatomy. HT appears to us as the only relevant procedure for colorectal cancer.
ISSN:0930-1038
1279-8517
DOI:10.1007/s00276-014-1281-y