The technique of primary arterial ligation for cancer of the colon as suggested by venous and lymphatic outflow studies.

Because veins and lymphatics constitute the major pathways for metastatic spread of cancer of the colon, the dynamics of venous and lymphatic outflow from the intestine were studied in dogs with use of electromagnetic flowmeter for the veins and cannulation and gravimetric measurement for the lymph. Venour ligation produced sixfold increases in lymph flow. Venous outflow doubled when adjacent veins were occluded but dropped when marginal vessels were ligated. Simultaneous ligation of arteries and veins caused significant decreases in lymph outflow (to 26% of control), but if arterial collaterals remained intact, lymph flow rose more than twofold. Venous outflow doubled after simultaneous occulusion of adjacent arteries and veins, but dropped as marginal vessels were ligated. Arterial ligation alone was most satisfactory, resulting in significant rapid decreases in lymph flow (to 32% of control) and venous flow (to 5% of control. As suggested by these studies, primary arterial ligation, followed by marginal vessel ligation, is being used as a modification of the "no touch" technique for cancer of the colon.