Low ligation inferior mesenteric artery versus selective sigmoidal artery ligation in sigmoid colon cancer: a comparative study

Abstract

Background: Ligation at the root of the inferior mesenteric artery (IMA) or ‘high-tie’ is widely accepted during oncologic resection of sigmoid colon cancer surgery. However, IMA ligation may compromise the anastomotic blood supply and risk injury to autonomic nerve plexus. The preservation of IMA or ‘low-tie’ may lead to increase blood flow and decrease postoperative bowel complications, nevertheless require longer operative time and technical difficulties. This study aims to compare the results between laparoscopic sigmoidectomy with selective sigmoidal artery ligation (group A) and low-ligation IMA (group B).Methods: A 1:2 case-matched comparative study and retrospective review of 27 patients with sigmoid cancer (19 female and 8 male) who underwent laparoscopic sigmoidectomy between January 2012 to December 2015. There were 9 patients in group A and 18 patients in group B. Perioperative results were collected and follow-up was recorded at 6 and 12 months after surgery.Results: There were no difference in the mean operative time {group A 194.44 (+28.77), group B 178.89 (+55.52), p=0.349}, blood loss {group A 94.44 (+52.71), group B 79.44 (+58.15), p=0.51}, and mean numbers of harvested lymph nodes {group A 14.56 (+3.74), group B 17.56 (+7.64), p=0.183}. Three patients in group B experienced a short period of stool frequency (2-4 weeks postoperative) and one with constipation. No leakage, bleeding, or tumor recurrence occurred in both groups during the 1 year follow up.Conclusions: Laparoscopic sigmoidectomy with selective sigmoidal artery ligation and lymph node dissection allows equivalent short-term oncologic results to low-ligation IMA technique.