Abstract
Purpose
Low-tie ligation in colorectal cancer surgery is associated with technical difficulties in left colic artery preservation. We aimed to evaluate and classify the anatomical and technical difficulties of left colic artery (LCA) preservation at its origin and along its route at the inferior border of the pancreas.
Methods
A vascular reconstruction computed tomography prospective series of 113 patients was analyzed. The inferior mesenteric artery (IMA) branching pattern according to Latarjet’s classification (Type I, separate LCA origin, Type II, fan-shaped branching pattern) and the distances between the IMA and the LCA origins and between the LCA and the Inferior mesenteric vein (IMV) at the inferior border of the pancreas were measured.
Results
The IMA branching pattern was Type I in 80 (71 %) patients and Type II in 33 (29 %) patients. The IMA-LCA distance was 39.8 ± 12.2 mm. The LCA-IMV distance at the inferior border of the pancreas was 20.5 ± 21.7 mm. When classified based on this distance, 75 (66 %) patients were classified into the Near subgroup (<20 mm) (7.7 ± 4.1 mm) and 38 (34 %) into the Far subgroup (≥20 mm) (45.6 ± 20.4 mm, p < 0.001). A Type I subgroup F accounted for 27 % of the patients.
Conclusions
Left colic artery preservation is highly feasible at its origin in more than two-thirds of cases due to the separate origin. The addition of a high IMV ligation increases the risk of damage to the LCA at the inferior border of the pancreas because the distance to the IMV is less than 20 mm in two-thirds of cases.
Similar content being viewed by others
References
Bertrand MM, Delmond L, Mazars R, Ripoche J, Macri F, Prudhomme M (2014) Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branching. Surg Radiol Anat 36:1057–1062
Bonnet S, Abid B, Wind P, Delmas V, Douard R (2013) Anatomical basis of laparoscopic medial-to-lateral mobilization of the descending colon. Clin Anat 26:377–385
Bonnet S, Berger A, Hentati N, Abid B, Chevallier JM, Wind P, Delmas V, Douard R (2012) High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum 55:515–521
Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR (2007) Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum 50:302–307
Buunen M, Lange MM, Ditzel M, Kleinrensink GJ, van de Velde CJ, Lange JF (2009) Level of arterial ligation in total mesorectal excision (TME): an anatomical study. Int J Colorectal Dis 24:1317–1320
Calan L, Gayet B, Bourlier P, Perniceni T (2004) Chirurgie du cancer du rectum par laparotomie et par laparoscopie. Encyclopédie MédicoChirurgicale Techniques chirurgicales -Appareil digestif. Elsevier Masson SAS, Paris, pp 40–630
Corder AP, Karanjia ND, Williams JD, Heald RJ (1992) Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg 79:680–682
Dwakin MJ, Allen-Mersh TG (1996) Effect of inferior mesenteric artery ligation on blood flow in the marginak artery-dependant sigmoid colon. J Ann Coll Surg 183:357–360
Hohenberger P, Schlag P, Kretzschmar U, Herfarth C (1991) Regional mesenteric recurrence of colorectal cancer after anterior resection or left hemicolectomy: inadequate primary resection demonstrated by angiography of the remaining arterial supply. Int J Colorectal Dis 6:17–23
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11:354–364
Kawamura YJ, Umetani N, Sunami E, Watanabe T, Masaki T, Muto T (2000) Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement. Eur J Surg 166:803–807
Kirkpatrick ID, Kroeker MA, Greenberg HM (2003) Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 229:91–98
Kobayashi M, Morishita S, Okabayashi T, Miyatake K, Okamoto K, Namikawa T, Ogawa Y, Araki K (2006) Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer. World J Gastroenterol 12:553–555
Lange MM, Buunen M, van de Velde CJ, Lange JF (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie: a review. Dis Colon Rectum 51:1139–1145
Lange JF, Komen N, Akkerman G, Nout E, Horstmanshoff H, Schlesinger F, Bonjer J, Kleinrensink GJ (2007) Riolan’s arch: confusing, misnomer, and obsolete. A literature survey of the connection(s) between the superior and inferior mesenteric arteries. Am J Surg 193:742–748
Latarjet A (1949) Traité d’anatomie humaine. In: Tome quatrième: appareil de la digestion. G Doin & Cie, Paris
Les cancers en France en 2013 (2014) Collection état des lieux et des connaissances, ouvrage collectif édité par l’INCa, Boulogne-Billancourt, France
Niculescu MC, Niculescu V, Ciobanu IC, Dăescu E, Jianu A, Sişu AM, Petrescu CI, Motoc A (2005) Correlations between the colic branches of the mesenteric arteries and the vascular territories of the colon. Rom J Morphol Embryol 46:193–197
Pezim ME, Nicholls RJ (1984) Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 200:729–733
Prevot F, Sabbagh C, Deguines JB, Potier A, Cosse C, Yzet T, Regimbeau JM (2013) Are there any surgical and radiological correlations to the level of ligation of the inferior mesenteric artery after sigmoidectomy for cancer? Ann Anat 195:467–474
Seike K, Koda K, Saito N, Oda K, Kosugi C, Shimizu K, Miyazaki M (2007) Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis 22:689–697
Sereno Trabaldo S, Anvari M, Leroy J, Marescaux J (2009) Prevalence of internal hernias after laparoscopic colonic surgery. J Gastrointest Surg 13:1107–1110
Shumeyko V, Eid I, Muir VH et al (2007) Routine division of the inferior mesenteric vein during left sided colonic surgery: will it leave the anastomosis hanging by a thread? In: Paper presented at the annual scientific meeting of the association of surgeons of Great Britain and Ireland, Manchester, England, April 2007
Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum 40:1205–1218
Surtees P, Ritchie JK, Phillips RK (1990) High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 77:618–621
Uehara K, Yamamoto S, Fujita S, Akasu T, Moriya Y (2007) Impact of upward lymph node dissection on survival rates in advanced lower rectal carcinoma. Dig Surg 24:375–381
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Patroni, A., Bonnet, S., Bourillon, C. et al. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 38, 477–484 (2016). https://doi.org/10.1007/s00276-015-1583-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-015-1583-8