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Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer()
BACKGROUND: Low ligation of the inferior mesenteric artery with preservation of the left colic artery may decrease the risk of colorectal anastomotic ischemia compared to high ligation at its origin. Low ligation leaves apical nodes in situ and is therefore paired with apical lymphadenectomy. We sou...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313841/ https://www.ncbi.nlm.nih.gov/pubmed/34337371 http://dx.doi.org/10.1016/j.sopen.2021.06.002 |
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author | Guidolin, Keegan Covelli, Andrea Chesney, Tyler R. Draginov, Arman Chadi, Sami A. Quereshy, Fayez A. |
author_facet | Guidolin, Keegan Covelli, Andrea Chesney, Tyler R. Draginov, Arman Chadi, Sami A. Quereshy, Fayez A. |
author_sort | Guidolin, Keegan |
collection | PubMed |
description | BACKGROUND: Low ligation of the inferior mesenteric artery with preservation of the left colic artery may decrease the risk of colorectal anastomotic ischemia compared to high ligation at its origin. Low ligation leaves apical nodes in situ and is therefore paired with apical lymphadenectomy. We sought to compare relevant oncologic outcomes between high ligation and low ligation plus apical lymphadenectomy in rectosigmoid resection for colorectal cancer. METHODS: We conducted a retrospective cohort study. Patients receiving a rectosigmoid resection for cancer between January 2012 and July 2018 were included. Patients with metastatic disease and those who underwent low ligation without apical lymphadenectomy were excluded. Our primary outcome was nodal yield/metastasis. Secondary outcomes included perioperative complications, local recurrence, and overall survival. RESULTS: Eighty-four patients underwent high ligation and 89 low ligation plus apical lymphadenectomy (median follow-up 20 months). In the low-ligation group, a median of 2 (interquartile range = 1–3) apical nodes was resected; 4.1% were malignant, increasing pathologic stage in 25% of these patients. There were no differences in nodal yield, complications, anastomotic leak, local recurrence, or overall survival. CONCLUSION: No differences were identified between high ligation and low ligation plus apical lymphadenectomy with respect to relevant clinical outcomes. Prospective trial data are needed to robustly establish the oncologic benefit and safety of the low ligation plus apical lymphadenectomy technique. |
format | Online Article Text |
id | pubmed-8313841 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-83138412021-07-31 Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() Guidolin, Keegan Covelli, Andrea Chesney, Tyler R. Draginov, Arman Chadi, Sami A. Quereshy, Fayez A. Surg Open Sci Article BACKGROUND: Low ligation of the inferior mesenteric artery with preservation of the left colic artery may decrease the risk of colorectal anastomotic ischemia compared to high ligation at its origin. Low ligation leaves apical nodes in situ and is therefore paired with apical lymphadenectomy. We sought to compare relevant oncologic outcomes between high ligation and low ligation plus apical lymphadenectomy in rectosigmoid resection for colorectal cancer. METHODS: We conducted a retrospective cohort study. Patients receiving a rectosigmoid resection for cancer between January 2012 and July 2018 were included. Patients with metastatic disease and those who underwent low ligation without apical lymphadenectomy were excluded. Our primary outcome was nodal yield/metastasis. Secondary outcomes included perioperative complications, local recurrence, and overall survival. RESULTS: Eighty-four patients underwent high ligation and 89 low ligation plus apical lymphadenectomy (median follow-up 20 months). In the low-ligation group, a median of 2 (interquartile range = 1–3) apical nodes was resected; 4.1% were malignant, increasing pathologic stage in 25% of these patients. There were no differences in nodal yield, complications, anastomotic leak, local recurrence, or overall survival. CONCLUSION: No differences were identified between high ligation and low ligation plus apical lymphadenectomy with respect to relevant clinical outcomes. Prospective trial data are needed to robustly establish the oncologic benefit and safety of the low ligation plus apical lymphadenectomy technique. Elsevier 2021-06-23 /pmc/articles/PMC8313841/ /pubmed/34337371 http://dx.doi.org/10.1016/j.sopen.2021.06.002 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Guidolin, Keegan Covelli, Andrea Chesney, Tyler R. Draginov, Arman Chadi, Sami A. Quereshy, Fayez A. Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title | Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title_full | Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title_fullStr | Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title_full_unstemmed | Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title_short | Apical lymphadenectomy during low ligation of the IMA during rectosigmoid resection for cancer() |
title_sort | apical lymphadenectomy during low ligation of the ima during rectosigmoid resection for cancer() |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313841/ https://www.ncbi.nlm.nih.gov/pubmed/34337371 http://dx.doi.org/10.1016/j.sopen.2021.06.002 |
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