Park Sung Sil, Park Boram, Park Eun Young, Park Sung Chan, Kim Min Jung, Sohn Dae Kyung, Oh Jae Hwan
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, Republic of Korea.
Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Surg Today. 2020 Jun;50(6):560-568. doi: 10.1007/s00595-019-01942-2. Epub 2020 Jan 6.
We compared the complication rates and oncologic and functional outcomes of high versus low ligation of the inferior mesenteric artery (IMA).
We reviewed data retrospectively from 776 patients, divided into high and low IMA ligation groups. Low ligation was performed with lymph node dissection around the IMA root. Postoperative complications and oncologic and functional outcomes were analyzed.
There were 613 patients in the high ligation group and 163 patients in the low ligation group. Most clinicopathological variables were similar. There were no significant differences in complication rates (25.1% vs. 28.8%; p = 0.336), anastomotic leakage (2.8% vs. 2.5%; p = 1.000), colonic ischemia (2.8% vs. 1.2%; p = 0.393), 5-year overall survival (79.6% vs. 81.3%; p = 0.137) or 5-year relapse-free survival (77.4% vs. 73.3%; p = 0.973) between the groups. In terms of functional outcomes, both techniques were equivalent. The International Prostate Symptom Score and Fecal Incontinence Severity Index were significantly better in the low ligation group 12 months postoperatively than 3 months postoperatively.
The oncologic and functional outcomes, as well as postoperative complications, after low ligation of the IMA with lymph node dissection are not significantly different from those after high ligation of the IMA.
我们比较了肠系膜下动脉（IMA）高位结扎与低位结扎的并发症发生率、肿瘤学及功能学结局。
我们回顾性分析了776例患者的数据，将其分为IMA高位结扎组和低位结扎组。低位结扎时在IMA根部周围进行淋巴结清扫。分析术后并发症、肿瘤学及功能学结局。
高位结扎组有613例患者，低位结扎组有163例患者。大多数临床病理变量相似。两组间在并发症发生率（25.1%对28.8%；p = 0.336）、吻合口漏（2.8%对2.5%；p = 1.000）、结肠缺血（2.8%对1.2%；p = 0.393）、5年总生存率（79.6%对81.3%；p = 0.137）或5年无复发生存率（77.4%对73.3%；p = 0.973）方面均无显著差异。在功能学结局方面，两种技术相当。低位结扎组术后12个月时的国际前列腺症状评分和大便失禁严重程度指数显著优于术后3个月时。
IMA低位结扎并清扫淋巴结后的肿瘤学及功能学结局以及术后并发症与IMA高位结扎后的情况无显著差异。
