Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Tours, France.
Department of General-, Visceral- and Transplant Surgery, University of Münster, Münster, Germany.
Anticancer Res. 2019 Aug;39(8):4363-4370. doi: 10.21873/anticanres.13605.
BACKGROUND/AIM: The aim of this study was to determine the clinical impact of low tie ligation (LT) of the inferior mesenteric artery (IMA) below the left colic artery versus high tie ligation (HT) at the origin of the IMA in patients undergoing rectal cancer surgery.
Between January 2005 and December 2017, all consecutive patients who underwent rectal resection for non-metastatic cancer were retrospectively included. Patients who had LT were compared to those who had HT.
Overall, 200 patients were identified (101 HT and 99 LT). Postoperative 30-day mortality rate was nil in both groups. There were significantly higher severe postoperative complications in HT versus LT patients (Clavien-Dindo III-IV) (18.8% vs. 9.1%, p=0.048). Median follow-up was 38.5 months and overall survival at 5 years was 91.5% and there was no difference between the two groups (90.1% vs. 92.9%; HT vs. LT p=0.640).
LT ligation of IMA significantly decreased the severe postoperative complication rate without affecting recurrence-free or overall survival.
背景/目的：本研究旨在确定在直肠癌手术中，于左结肠动脉下方行肠系膜下动脉（IMA）低位结扎（LT）与在 IMA 起点行高位结扎（HT）相比的临床影响。
2005 年 1 月至 2017 年 12 月，所有连续接受非转移性直肠癌切除术的患者均被回顾性纳入研究。比较 LT 组与 HT 组患者。
共纳入 200 例患者（HT 组 101 例，LT 组 99 例）。两组患者术后 30 天死亡率均为零。HT 组患者术后严重并发症（Clavien-Dindo III-IV）发生率明显高于 LT 组（18.8% vs. 9.1%，p=0.048）。中位随访时间为 38.5 个月，两组患者 5 年总生存率无差异（91.5% vs. 92.9%；HT 组 vs. LT 组，p=0.640）。
IMA 的 LT 结扎可显著降低术后严重并发症发生率，而不影响无复发生存率或总生存率。
