Safety and effectiveness of high ligation of the inferior mesenteric artery for cancer of the descending colon under indocyanine green fluorescence imaging: a pilot study
| Autor: | Yoichiro Yoshida, Hideki Nagano, Taro Munechika, Gumpei Yoshimatsu, Akira Komono, Naoya Aisu, Yoshiko Matsumoto, Suguru Hasegawa, Ryuji Kajitani, Mitsuaki Morimoto |
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| Rok vydání: | 2019 |
| Předmět: |
Indocyanine Green
Male medicine.medical_specialty Colorectal cancer Pilot Projects Inferior mesenteric artery Descending colon 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Postoperative Complications medicine.artery medicine Humans Prospective Studies Mesentery Ligation Colectomy Aged Aged 80 and over business.industry Anastomosis Surgical Optical Imaging Sigmoid colon Cancer Mesenteric Artery Inferior Middle Aged medicine.disease digestive system diseases Surgery Colon Descending medicine.anatomical_structure Treatment Outcome chemistry 030220 oncology & carcinogenesis Colonic Neoplasms 030211 gastroenterology & hepatology Female Lymph Nodes business Indocyanine green |
| Zdroj: | Surgical endoscopy. 35(4) |
| ISSN: | 1432-2218 |
| Popis: | Complete mesocolic excision with central vascular ligation is a standard advanced technique for achieving favorable long-term oncological outcomes in colon cancer surgery. Clinical evidence abounds demonstrating the safety of high ligation of the inferior mesenteric artery (IMA) for sigmoid colon cancer but is scarce for descending colon cancer. A major concern is the blood supply to the remnant distal sigmoid colon, especially for cases with a long sigmoid colon. We sought to clarify the safety and feasibility of high ligation of the IMA in surgery for descending colon cancer using indocyanine green (ICG) fluorescence imaging. In this prospective single-center pilot study, we examined 20 patients with descending colon cancer who underwent laparoscopic colectomy between April 2018 and September 2019. Following full mobilization and division of the proximal colonic mesentery, we temporarily clamped the root of the IMA and performed ICG fluorescence imaging of the blood flow to the sigmoid colon. The postoperative anastomosis-related complications (primary endpoint) and length of viable remnant colon, and the number of lymph nodes retrieved (secondary endpoints) were evaluated and compared with historical controls who underwent conventional IMA-preserving surgery (n = 20). Blood flow reached 40 (17–66) cm retrograde from the peritoneal reflection, even after IMA clamping. Accordingly, IMA high ligation was performed in all cases. No anastomotic anastomosis-related complications occurred in each group. Retrieved total lymph nodes were higher in number in the ICG-guided group than in the conventional group (p = 0.035). Specifically, more principal nodes were retrieved in the ICG-guided group, compared with the conventional group (p = 0.023). However, the distal margin was not as long compared with the conventional group. We demonstrated the safety and feasibility of high ligation of the IMA for descending colon cancer without sacrificing additional distal colon using fluorescence evaluation of blood flow in the remnant colon. |
| Databáze: | OpenAIRE |
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