Department of General Surgery, University of Perugia, St. Maria Hospital, Via Tristano di Joannuccio, 05100 Terni, Italy.
Surg Oncol. 2012 Sep;21(3):e111-23. doi: 10.1016/j.suronc.2012.04.004. Epub 2012 Jul 6.
Nowadays left colon and rectal cancer treatment has been well standardized in both open and laparoscopy. Nevertheless, the level of the ligation of the inferior mesenteric artery (IMA), at the origin from the aorta (high tie) or below the origin of the left colic artery (low tie), is still debated. The objective of the systematic review is to evaluate the current scientific evidence of high versus low tie of the IMA in colorectal cancer surgery. The outcomes considered were overall 30-days postoperative morbidity, overall 30-days postoperative mortality, anastomotic leakage, 5-years survival rate, and overall recurrence rate. A total of 8.666 patients were included in our analysis, 4.281 forming the group undergoing high tie versus 4.385 patients undergoing low tie. Neither the high tie nor the low tie strategy showed an evidence based success, as no statistically significant differences were identified for all outcomes measured. Future high powered and well designed randomized clinical trials are needed to draw definitive conclusion on this dilemma.
目前，开腹手术和腹腔镜手术治疗左半结肠癌和直肠癌已经得到了很好的规范。然而，在离断肠系膜下动脉（IMA）时，究竟是在主动脉起源处（高位结扎）还是在左结肠动脉起源处下方（低位结扎），仍存在争议。本系统评价的目的是评估结直肠癌手术中IMA 高位结扎与低位结扎的当前科学证据。考虑的结果是总体 30 天术后发病率、总体 30 天术后死亡率、吻合口漏、5 年生存率和总体复发率。共有 8666 名患者纳入我们的分析，其中 4281 名患者行高位结扎，4385 名患者行低位结扎。高位结扎和低位结扎策略都没有证据表明成功，因为所有测量的结果都没有统计学上的显著差异。需要未来进行高功率和精心设计的随机临床试验，才能对这一困境得出明确的结论。
