Elisa Francone1, Pierfrancesco Bonfante2, Maria Santina Bruno2, Donatella Intersimone3, Emilio Falco2, Stefano Berti2. 1. Department of Surgery, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy. elisafrancone@gmail.com. 2. Department of Surgery, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy. 3. Department of Pathological Anatomy, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy.
Abstract
BACKGROUND: In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage onset, real oncological benefits and possible disadvantages related to vascular transection level are still on debate. We introduce totally laparoscopic inferior mesenteric artery peeling technique to release from the concept of lymph nodal harvesting linked to arterial transection level. METHODS: Over a period of 24 months, 31 patients presenting with sigmoid cancer were submitted to laparoscopic sigmoidectomy associated with inferior mesenteric artery peeling. Data on intraoperative and postoperative outcomes have been prospectively collected. RESULTS: Mean operative time was 180 min (range 110-330 min); mean intraoperative blood loss was 60 ml (range 30-150 ml), and mean postoperative hospitalization was 6.2 days (range 4-11 days). Mean number of lymph node harvested was 16.7 (range 12-28). CONCLUSIONS: Given a proper selection of patients, laparoscopic sigmoidectomy comprehensive of sub-adventitial IMA skeletonization from its aortic origin could provide good oncological outcomes and recanalization rate. Further data are advocated to confirm these preliminary results.
BACKGROUND: In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage onset, real oncological benefits and possible disadvantages related to vascular transection level are still on debate. We introduce totally laparoscopic inferior mesenteric artery peeling technique to release from the concept of lymph nodal harvesting linked to arterial transection level. METHODS: Over a period of 24 months, 31 patients presenting with sigmoid cancer were submitted to laparoscopic sigmoidectomy associated with inferior mesenteric artery peeling. Data on intraoperative and postoperative outcomes have been prospectively collected. RESULTS: Mean operative time was 180 min (range 110-330 min); mean intraoperative blood loss was 60 ml (range 30-150 ml), and mean postoperative hospitalization was 6.2 days (range 4-11 days). Mean number of lymph node harvested was 16.7 (range 12-28). CONCLUSIONS: Given a proper selection of patients, laparoscopic sigmoidectomy comprehensive of sub-adventitial IMA skeletonization from its aortic origin could provide good oncological outcomes and recanalization rate. Further data are advocated to confirm these preliminary results.
Authors: Koianka Trencheva; Kevin P Morrissey; Martin Wells; Carol A Mancuso; Sang W Lee; Toyooki Sonoda; Fabrizio Michelassi; Mary E Charlson; Jeffrey W Milsom Journal: Ann Surg Date: 2013-01 Impact factor: 12.969