Level of arterial ligation in sigmoid colon and rectal cancer surgery.
Level of arterial ligation in sigmoid colon and rectal cancer surgery.
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DOI：
10.1186/s12957-016-0819-3
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发表时间：
2016-04-01
影响因子：
3.2
通讯作者：
Watanabe T
中科院分区：
文献类型：
--
作者：
Yasuda K;Kawai K;Ishihara S;Murono K;Otani K;Nishikawa T;Tanaka T;Kiyomatsu T;Hata K;Nozawa H;Yamaguchi H;Aoki S;Mishima H;Maruyama T;Sako A;Watanabe T
乙状结肠和直肠癌的根治性切除包括肠系膜下动脉(IMA)的“高位结扎”。然而，IMA结扎损害了吻合口的血流，这可能会增加渗漏率，目前还不清楚这是否提供了生存优势。相应地，IMA可以在左结肠动脉(LCA)起始处的正下方结扎，结合围绕IMA起始处的淋巴结清扫(LND)(低位结扎LND)。然而，还没有研究调查“高领带”和“低领带与LND”之间的详细预后结果。本研究的目的是评估“低位LND”对乙状结肠癌或直肠癌患者生存率的影响。本研究纳入1997-2007年间接受根治性手术的189例乙状结肠或直肠癌患者。复习患者的医疗记录以获得临床病理信息。采用Kaplan-Meier方法计算总生存率(OS)和无复发生存率(RFS)，差异采用对数等级检验。42 14 7例患者分别在颈总动脉起始部结扎(高位结扎)和在颈总动脉起始部正下方联合低位结扎(低位结扎)。两组并发症发生率、OS和RFS发生率无显著差异。此外，在两组淋巴结阳性病例中，OS和RFS的发生率没有显著差异。“低位结合LND”在解剖学上具有较小的侵袭性，在预后方面不逊于“高位”。
Curative resection of sigmoid colon and rectal cancer includes “high tie” of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate, and it is unclear whether this confers a survival advantage. Accordingly, the IMA may be ligated at a point just below the origin of the left colic artery (LCA) “low tie” combined with lymph node dissection (LND) around the origin of the IMA (low tie with LND). However, no study has investigated the detailed prognostic results between “high tie” and “low tie with LND.” The aim of this study was to assess the utility of “low tie with LND” on survival in patients with sigmoid colon or rectal cancer. A total of 189 sigmoid colon or rectal cancer patients who underwent curative operation from 1997 to 2007 were enrolled in this study. The patient’s medical records were reviewed to obtain clinicopathological information. Overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method, with differences assessed using log-rank test. Forty-two and 147 patients were ligated at the origin of the IMA (high tie) and just below the origin of the LCA combined with LND around the origin of the IMA (low tie with LND), respectively. No significant differences were observed in the complication rate and OS and RFS rates in the two groups. Further, no significant difference was observed in the OS and RFS rates in the lymph node-positive cases in the two groups. “Low tie with LND” is anatomically less invasive and is not inferior to “high tie” with prognostic point of view.