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Level of inferior mesenteric artery ligation in low rectal cancer surgery: high tie preferred over low tie

  • E. GirardEmail author
  • B. Trilling
  • P.-Y. Rabattu
  • P.-Y. Sage
  • N. Taton
  • Y. Robert
  • P. Chaffanjon
  • J.-L. Faucheron
Short Communication
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Abstract

Background

There is no demonstrated benefit of high-tie versus low-tie vascular transections in low rectal cancer surgery. The aim of this study was to compare the effects of high tie and low tie of the inferior mesenteric artery on colonic length.

Methods

This study was conducted in a surgical anatomy research laboratory. Anatomical dissections were performed on 11 human cadavers. We performed full left colonic mobilization, section of the descending-sigmoid junction, and high and low ligation of the inferior mesenteric artery. Distance from the proximal colon limb to the lower edge of the pubis symphysis was recorded after each step of vascular division. Three measurements were successively performed: before vascular section, after inferior mesenteric artery ligation, and after inferior mesenteric artery and vein section.

Results

Before vascular section, the mean distance between colonic end and lower edge of the symphysis pubis was − 1.9 ± 3.5 cm. After combined artery and vein section, the mean distance was + 10.7 ± 4.6 cm for high tie and + 1.5 ± 3 cm for low tie. A limitation of this study is the use of embalmed anatomical specimens, rather than live patients, and the small number of specimens. This study also does not evaluate colon limb vascularization or the impact of proximal lymph node dissection on survival rates.

Conclusions

High tie of the inferior mesenteric artery at its aortic origin allows a gain of extra length of about 9 cm over low tie.

Keywords

Rectal cancer Inferior mesenteric artery Vascular anatomy High tie 

Notes

Compliance with ethical standards

Conflict of interest

Pr. Faucheron received honoraria for punctual interventions, punctual consultancies, and had some reimbursed travels, and pre-paid subscriptions for meetings from AMI, Covidien, Medtronic, Ethicon, MSD, Legrand, Takeda, and Johnson & Johnson Beauté Santé France. Drs. Girard, Trilling, Rabattu, Sage, Taton, Robert, and Chaffanjon have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • E. Girard
    • 1
    • 2
    • 3
    • 4
    Email author
  • B. Trilling
    • 1
    • 2
    • 3
  • P.-Y. Rabattu
    • 3
  • P.-Y. Sage
    • 1
  • N. Taton
    • 1
  • Y. Robert
    • 3
  • P. Chaffanjon
    • 3
  • J.-L. Faucheron
    • 1
    • 2
  1. 1.Colorectal Unit, Department of SurgeryGrenoble Alps University HospitalGrenobleFrance
  2. 2.UMR 5525, CNRS, TIMC-IMAG, Grenoble Alps UniversityGrenobleFrance
  3. 3.LADAF (Anatomy Laboratory of the French Alps)Grenoble Alps University HospitalGrenobleFrance
  4. 4.Département de chirurgie digestive et de l’urgenceHôpital Albert MichallonGrenobleFrance

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