Kim Cho Shin, Kim Sohyun
Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea.
Ann Coloproctol. 2019 Aug;35(4):167-173. doi: 10.3393/ac.2018.10.09. Epub 2019 Aug 31.
We assessed the oncologic and anastomotic benefits of low ligation of the inferior mesenteric artery (IMA) with additional lymph node (LN) retrieval.
We performed a retrospective case-control study between January 2011 and July 2015. All patients underwent curative resection of a primary sigmoid or rectal tumor. We excluded patients with distant metastases at the time of diagnosis. The case group included patients who underwent high ligation of the IMA (high group, HG). The control group included patients who underwent low ligation of the IMA with low group with additional LN retrieval (LGAL). Controls were identified by matching patients based on age (±5 years), sex, tumor location, and final histopathological stage. Finally, each group included 97 patients.
Clinical characteristics did not significantly differ between groups. The mean number of additional harvested LN was 2.19 (range, 0-11), and one patient in the LGAL had a metastatic LN among the additional harvested LN. The overall morbidity was 22.7% in the HG and 30% in the LGAL (P = 0.257). Anastomotic leakage occurred in 14 patients (14.4%) in the HG and 5 patients (5.2%) in the LGAL (P = 0.030). The mean disease-free survival time in the HG was longer than that in the LGAL (P = 0.008). The mean overall survival (OS) time was 70.4 ± 1.3 months. The mean OS was 63.7 ± 1.6 months in the HG and 69.1 ± 2.6 months in the LGAL (P = 0.386).
Low ligation of the IMA with additional LN retrieval is technically safe. However, the oncologic effect was better after high ligation of IMA.
我们评估了肠系膜下动脉（IMA）低位结扎联合额外淋巴结（LN）清扫的肿瘤学及吻合口获益情况。
我们在2011年1月至2015年7月间进行了一项回顾性病例对照研究。所有患者均接受了原发性乙状结肠或直肠肿瘤的根治性切除。我们排除了诊断时伴有远处转移的患者。病例组包括接受IMA高位结扎的患者（高位组，HG）。对照组包括接受IMA低位结扎联合额外LN清扫的患者（低位联合LN清扫组，LGAL）。通过根据年龄（±5岁）、性别、肿瘤位置和最终组织病理学分期匹配患者来确定对照组。最后，每组包括97例患者。
两组间临床特征无显著差异。额外清扫的LN平均数量为2.19个（范围0 - 11个），LGAL组中有1例患者在额外清扫的LN中有转移LN。HG组总体发病率为22.7%，LGAL组为30%（P = 0.257）。HG组有14例患者（14.4%）发生吻合口漏，LGAL组有5例患者（5.2%）发生吻合口漏（P = 0.030）。HG组的平均无病生存时间长于LGAL组（P = 0.008）。平均总生存（OS）时间为70.4 ± 1.3个月。HG组的平均OS为63.7 ± 1.6个月，LGAL组为69.1 ± 2.6个月（P = 0.386）。
IMA低位结扎联合额外LN清扫在技术上是安全的。然而，IMA高位结扎后的肿瘤学效果更好。
