Apical lymph node dissection and low ligation of inferior mesenteric artery in the management of distal colorectal cancer

Aim
Curative resection of sigmoid and rectal cancer includes high ligation of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate, and carries the possibility of injury of autonomic nerve plexus. Accordingly, in this study we employ a technique of lymph node (LN) dissection around the IMA, preserving the IMA and left colic artery (LCA) and compare it with high and low ligation
Background
Nowadays surgery for colorectal cancer has been standardized both ways in open and laparoscopic approaches. But there are still debates regarding the level of ligation of the IMA: at its origin from aorta (high ligation) or below the origin of left colic artery (low ligation). The technique of apical lymph node dissection with preservation of LCA has the advantage of both, better lymph node harvest and lower postoperative complications
Materials and methods
This is a prospective study which included 81 patients with operable distal colo-rectal cancer admitted to general surgery department in Menoufia University Hospitals from May 2012 to October 2015. Cases were divided by random serial number method into three groups: group (A) 27 cases for high ligation, group (B) 27 cases for low ligation and group(C) 27 cases for low ligation and apical lymph node dissection.
Results
There was high significant difference between the studied groups regarding to the number of harvested lymph nodes with Mean ± SD 18.3 ± 4.05 for high ligation versus 11.3+3.2 for low ligationand17.7+3.81 for apical dissection. also there was significant difference between studied groups as regarding the postoperativegenito-urinary complications.
Conclusions
Lymph node dissection around the IMA preserving the root of the IMA and LCA was feasible by our method, without compromising operation time, blood loss or the number of harvested lymph nodes with accepted rate of postoperative complications.