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Preservation of left colic artery in laparoscopic colorectal operation: The benefit challenge

World Journal of Gastrointestinal Surgery 2023年第5期15卷 825-833页

作者： Fu-Cheng Liu Jian-Ning Song Ying-Chi Yang Zhong-Tao Zhang General Surgery Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China General Surgery Beijing Fengtai HospitalBeijing 100071China

BACKGROUND During laparoscopic resection for colorectal cancer,there is controversy regarding whether the left colic artery(LCA)should be preserved at its *** To investigate the prognostic significance of preservation of the LCA in colorectal cancer *** Patients were divided into two *** high ligation(H-L)technique(refers to ligation performed 1 cm from the beginning of the inferior mesenteric artery)group consisted of 46 patients,and the low ligation(L-L)technique(refers to ligation performed below the initiation of the LCA)group consisted of 148 *** time,blood loss,lymph nodes with tumor invasion,postoperative complications and recovery time,recurrence rate,and 5-year survival rate were compared between the two *** The average number of lymph nodes detected in postoperative pathological specimens was 17.4/person in the H-L group and 15.9/person in the L-L *** were 20 patients(43%)with positive lymph nodes(lymph node metastasis)in the H-L group and 60 patients(41%)in the L-L *** statistical differences were found between the *** occurred in 12 cases(26%)in the H-L group and in 26 cases(18%)in the L-L *** incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L *** 5-year survival rates in H-L and L-L groups were 81.7%and 81.6%,respectively,and relapse-free survival rates were 74.3%and 77.1%,*** two groups were similar *** Complete mesenteric resection combined with lymph node dissection around the inferior mesenteric artery root while preserving the LCA is a beneficial surgical approach during laparoscopic resection for colorectal cancer.

关键词： Cancer Complete mesenteric resection inferior mesenteric artery Urinary complications Lymph

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inferior mesenteric arteriovenous fistula during treatment with bevacizumab in colorectal cancer patient: A case report

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World Journal of Gastrointestinal Oncology 2020年第11期12卷 1364-1371页

作者： Ayako Doi Hiroyuki Takeda Kumiko Umemoto Ryosuke Oumi Shinji Wada Shingo Hamaguchi Hidefumi Mimura Hiroyuki Arai Yoshiki Horie Takuro Mizukami Naoki Izawa Takashi Ogura Takako EguchiNakajima Yu Sunakawa Department of Clinical Oncology St.Marianna University School of MedicineKanagawa 216-8511Japan Department of Gastroenterology St.Marianna University School of MedicineKanagawa 216-8511Japan Department of Radiology St.Marianna University School of MedicineKanagawa 216-8511Japan Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy Kyoto University HospitalKyoto 606-8507Japan

BACKGROUND Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula(IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer(mCRC) after colon *** SUMMARY An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after *** Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.

关键词： Metastatic cancer Colon surgery Chemotherapy Fistula formation inferior mesenteric artery Interventional radiology Case report

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Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

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World Journal of Gastrointestinal Oncology 2020年第6期12卷 632-641页

作者： Jia-Nan Chen Zheng Liu Zhi-Jie Wang Fu-Qiang Zhao Fang-Ze Wei Shi-Wen Mei Hai-Yu Shen Juan Li Wei Pei Zheng Wang Jun Yu Qian Liu Department of Colorectal Surgery National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union CollegeBeijing 100021China Department of Surgery the Johns Hopkins University School of MedicineBaltimoreMD 21218United States

BACKGROUND For laparoscopic rectal cancer surgery,the inferior mesenteric artery(IMA)can be ligated at its origin from the aorta[high ligation(HL)]or distally to the origin of the left colic artery[low ligation(LL)].Whether different ligation levels are related to different postoperative complications,operation time,and lymph node yield remains ***,we designed this study to determine the effects of different ligation levels in rectal cancer *** To investigate the operative results following HL and LL of the IMA in rectal cancer *** From January 2017 to July 2019,this retrospective cohort study collected information from 462 consecutive rectal cancer *** to the ligation level,235 patients were assigned to the HL group while 227 patients were assigned to the LL *** regarding the clinical characteristics,surgical characteristics and complications,pathological outcomes and postoperative recovery were obtained and compared between the two groups.A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage(AL).RESULTS Compared to the HL group,the LL group had a significantly lower AL rate,with 6(2.8%)cases in the LL group and 24(11.0%)cases in the HL group(P=0.001).The HL group also had a higher diverting stoma rate(16.5%vs 7.5%,P=0.003).A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL(OR=3.599;95%CI:1.374-9.425;P=0.009),tumor located below the peritoneal reflection(OR=2.751;95%CI:0.772-3.985;P=0.031)and age(≥65 years)(OR=2.494;95%CI:1.080-5.760;P=0.032)were risk factors for *** were no differences in terms of patient demographics,pathological outcomes,lymph nodes harvested,blood loss,hospital stay and urinary function(P>0.05).CONCLUSION In rectal cancer surgery,LL should be the preferred method,as it has a lower AL and diverting stoma rate.

关键词： Rectal neoplasms inferior mesenteric artery Anastomotic leakage Laparoscopy Ligation Postoperative complications

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Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography

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World Journal of Gastroenterology 2020年第24期26卷 3484-3494页

作者： Chao Zhang Ang Li Tao Luo Yu Li Fei Li Jia Li Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Gastroenteropancreatic Center National Clinical Research Center for Geriatric DiseasesBeijing 100053China

BACKGROUND Handling of the inferior mesenteric artery(IMA)and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal ***,the branching of this artery and the drainage patterns of this vein vary among individuals,and the characteristics and perfusion region of this artery in elderly patients remain *** To evaluate the characteristics and perfusion region of the IMA in elderly patients using *** We enrolled 154 patients(>65 years old)who underwent digital subtraction angiography of the *** characteristics,bifurcation,and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction *** arterial arches and the IMA hemoperfusion region were also *** regions were cross-referenced with clinical and anatomical features by the univariate *** Of 154 patients,25(16.2%)had IMA *** left colic artery arose independently from the IMA in 44.2%of patients,shared a trunk with the sigmoid artery in 35.1%,shared an opening with the sigmoid and superior rectal arteries in 16.9%,and was absent in 5.1%.The IMA perfusion region stopped at the splenic flexure in 50(32.5%)*** collateral circulation existed in the colonic perfusion region,including the marginal artery(Drummond’s artery),the ascending branch of the left colonic artery to supply the transverse colon,and the arc of Riolan with a frequency of 100%,22.7%,and 1.9%,*** IMA perfusion region was independently associated with the comorbidity of atherosclerosis,IMA atherosclerotic lesion,branching pattern,collateral circulation,and marginal artery *** The IMA and its branches are prone to arteriosclerosis,and IMA perfusion may be interrupted at the splenic flexure in elderly *** applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion pat

关键词： Anatomy Digital subtraction angiography Elderly inferior mesenteric artery Left-sided colorectum

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