Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2019

01-06-2019 | Rectal Cancer | Review

Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis

Authors: Mou-Bo Si, Pei-Jing Yan, Zhen-Ying Du, Lai-Yuan Li, Hong-Wei Tian, Wen-Jie Jiang, Wu-Tang Jing, Jia Yang, Cai-Wen Han, Xiu-E Shi, Ke-Hu Yang, Tian-Kang Guo

Published in: International Journal of Colorectal Disease | Issue 6/2019

Login to get access

Abstract

Purpose

The aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries.

Methods

PubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes.

Results

In total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively.

Conclusions

LL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.
Appendix
Available only for authorised users
Literature
1.
2.
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis: Off J Assoc Coloproctology of Great Britain and Ireland 11:354–364 discussion 364-355 CrossRef
3.
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefPubMed
4.
Fujii S, Ishibe A, Ota M, Watanabe K, Watanabe J, Kunisaki C, Endo I (2018) Short-term results of a randomized study between high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: sub analysis of HTLT (high-tie vs low-tie) study. Surgical Endoscopy and Other Interventional Techniques Conference: 16th World Congress of Endoscopic Surgery United States, DOI: https://​doi.​org/​10.​1007/​s00464-018-6119-y
5.
Fan Y-C, Ning F-L, Zhang C-D, Dai D-Q (2018) Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: a meta-analysis. Int J Surg 52:277–285
6.
Zeng JS, Su GQ (2018) High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis. World Journal of Surgical Oncology 16(1 Article Number):157CrossRefPubMedPubMedCentral
7.
Matsuda K, Hotta T, Takifuji K, Yokoyama S, Oku Y, Watanabe T, Mitani Y, Ieda J, Mizumoto Y, Yamaue H (2015) Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg 102:501–508CrossRefPubMed
8.
Ikeda Y, Shimabukuro R, Saitsu H, Saku M, Maehara Y (2007) Influence of prophylactic apical node dissection of the inferior mesenteric artery on prognosis of colorectal cancer. Hepato-gastroenterology 54:1985–1987PubMed
9.
Corder AP, Karanjia ND, Williams JD, Heald RJ (1992) Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal-carcinoma. Br J Surg 79:680–682CrossRefPubMed
10.
Tian J, Zhang J, Ge L, Yang K, Song F (2017) The methodological and reporting quality of systematic reviews from China and the USA are similar. J Clin Epidemiol 85:50–58CrossRefPubMed
11.
Wang X, Chen Y, Yao L, Zhou Q, Wu Q, Estill J, Wang Q, Yang K, Norris SL (2018) Reporting of declarations and conflicts of interest in WHO guidelines can be further improved. J Clin Epidemiol 98:1–8CrossRefPubMed
12.
13.
Singh D, Luo J, X-t L, Ma Z, Cheng H, Yu Y, Yang L, Zhou Z-G (2017) The long-term survival benefits of high and low ligation of inferior mesenteric artery in colorectal cancer surgery: a review and meta-analysis. Medicine 96:e8520CrossRefPubMedPubMedCentral
14.
Chen SC, Song XM, Chen ZH, Li MZ, He YL, Zhan WH (2010) Role of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery: a meta-analysis. Chin J Gastrointes Surg 9:674–677
15.
Kanemitsu Y, Hirai T, Komori K, Kato T (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93:609–615CrossRefPubMed
16.
Hida J, Okuno K, Yasutomi M, Yoshifuji T, Matsuzaki T, Uchida T, Ishimaru E, Tokoro T, Shiozaki H (2005) Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg 201:217–222CrossRefPubMed
17.
Ge L, Tian JH, Li YN, Pan JX, Li G, Wei D, Xing X, Pan B, Chen YL, Song FJ, Yang KH (2018) Association between prospective registration and overall reporting and methodological quality of systematic reviews: a meta-epidemiological study. J Clin Epidemiol 93:45–55CrossRefPubMed
18.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed) 343:d5928CrossRef
19.
Xiu-xia L, Ya Z, Yao-long C, Ke-hu Y, Zong-jiu Z (2015) The reporting characteristics and methodological quality of Cochrane reviews about health policy research. Health policy (Amsterdam, Netherlands) 119:503-510
20.
Pezim ME, Nicholls RJ (1984) Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 200:729–733CrossRefPubMedPubMedCentral
21.
Surtees P, Ritchiei JK, Phillips RKS (1990) High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 77:618–621CrossRefPubMed
22.
Gao YF, Jiang JB, Sun RX, Tu-CL (1999) A clinical assessment for using high ligation of the inferior mesenteric artery and extensive lymphadenectomy in advanced rectal cancer. Chin J Gastrointest Surg 2:100–103
23.
Chen CQ, Zhan WH, Wang P, Chen ZX, Huang YH, He YL, Lan P (2000) High ligation of the inferior mesenteric artery affect patient prognosis following resection of rectal cancer. Chin J Cancer 19:918–921
24.
Kawamura YJ, Umetani N, Sunami E, Watanabe T, Masaki T, Muto T (2000) Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement. Eur J Surg 166:803–808CrossRefPubMed
25.
Komen N, Slieker J, Kort P, Wilt JHW, Harst E, Coene P, Gosselink M, Tetteroo G, Beek E, Toom R, Bockel W, Verhoef C, Lange J (2011) High tie versus low tie in rectal surgery: comparison of anastomotic perfusion. Int J Color Dis 26:1075–1078CrossRef
26.
Sekimoto M, Takemasa I, Mizushima T, Ikeda M, Yamamoto H, Doki Y, Mori M (2011) Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery. Surg Endosc Other Interv Tech 25:861–866CrossRef
27.
Rutegard M, Hemmingsson O, Matthiessen P, Rutegard J (2012) High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 99:127–132CrossRefPubMed
28.
Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, Sugihara K, Watanabe M (2013) Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37:2935–2943CrossRefPubMed
29.
Mihara Y, Kochi M, Fujii M, Kanamori N, Funada T, Teshima Y, Jinno D, Takayama T (2014) Resection of colorectal cancer with versus without preservation of inferior mesenteric artery. Am J Clin Oncol 40:381–385CrossRef
30.
Yamamoto M, Okuda J, Tanaka K, Ishii M, Hamamoto H, Uchiyama K (2014) Oncological impact of laparoscopic lymphadenectomy with preservation of the left colic artery for advanced sigmoid and rectosigmoid colon cancer. Dig Surg 31:452–458CrossRefPubMed
31.
Boström P, Haapamäki MM, Matthiessen P, Ljung R, Rutegard J, Rutegard M (2015) High arterial ligation and risk of anastomotic leakage in anterior resection for rectal cancer in patients with increased cardiovascular risk. Color Dis 17:1018–1027CrossRef
32.
Charan I, Kapoor A, Singhal MK, Jagawat N, Bhavsar D, Jain V, Kumar V, Kumar HS (2015) High ligation of inferior mesenteric artery in left colonic and rectal cancers: lymph node yield and survival benefit. Indian J Surg 77:S1103–S1108CrossRef
33.
Guo YC, Wang DG, He L, Zhang Y, Zhao SS, Zhang LY, Sun X, Suo J (2015) Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial. ANZ J Surg 87:576–581CrossRefPubMed
34.
Tanaka J, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Kawai K, Kazama S, Nozawa H, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Watanabe T (2015) Analysis of anastomotic leakage after rectal surgery: a case-control study. Ann Med Surg (2012) 4:183–186
35.
Wang QG, Zhang CK, Zhang HY, Wang YH, Yuan ZG, Qu C (2015) Effect of ligation level of inferior mesenteric artery on postoperative defecation function in patients with rectal cancer. Chin J Gastrointest Surg 18:1132–1135
36.
Rutegård M, Hassmén N, Haapamäki MM, Matthiessen P, Rutegård J (2016) Anterior resection for rectal cancer and visceral blood flow: an explorative study. Scand J Surg: SJS: Off Organ Finnish Surg Soc Scand Surg Soc 105:78–83
37.
Yasuda K, Kawai K, Ishihara S, Murono K, Otani K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Yamaguchi H, Aoki S, Mishim H, Maruyama T, Sako A, Watanabe T (2016) Level of arterial ligation in sigmoid colon and rectal cancer surgery. World J Surg Oncology 14:1 Article Number: 99
38.
Zhang LY, Zang L, Ma JJ, Dong F, He ZR, Zheng MH (2016) Preservation of left colic artery in laparoscopic radical operation for rectal cancer. Chin J Gastrointest Surg 19:886–891
39.
Wu YJ, Li M (2017) Left colon artery preservation in laparoscopic anterior rectal resection: a clinical study. Chin J Gastrointest Surg 20:1313–1315
40.
You XL, Wang YJ, Chen ZY, Li WQ, Xu N, Liu GY, Zhao XJ, Huang CJ (2017) Clinical study of preserving left colic artery during laparoscopic total mesorectal excision for the treatment of rectal cancer. Chinese Journal of Gastrointestinal Surgery 20:1162–1167
41.
Dimitriou N, Felekouras E, Karavokyros I, Pikoulis E, Vergadis C, Nonni A, Griniatsos J (2018) High versus low ligation of inferior mesenteric vessels in rectal cancer surgery: a retrospective cohort study. J BUON: Off J Balkan Union Oncol 23:1350–1361
42.
Lee KH, Kim JS, Kim JY (2018) Feasibility and oncologic safety of low ligation of inferior mesenteric artery with D3 dissection in cT3N0M0 sigmoid colon cancer. Ann Surg Treat Res 94:209–215CrossRefPubMedPubMedCentral
43.
Fen WQ, Zong YP, Sun J, Li W, Zhu CC, Miao YM, Zheng MH, Lu AG (2018) High ligation versus low ligation of the inferior mesenteric artery and lymph node dissection in laparoscopic rectal cancer surgery. Chin J Gen Surg 33:563–566
44.
Olofsson F, Buchwald P, Elmstahl S, Syk I (2018) High tie or not in resection for cancer in the sigmoid colon? Scand J Surg:1457496918812198
45.
Xu T, Hu JT (2018) Effect of low ligation and high ligation of inferior mesenteric artery on laparoscopic radical resection of rectal cancer. Chin J Operative Procedures of Gen Surg (Electronic Version) 12:144–147
46.
Zhou JM, Tan SY, Huang J, Huang PZ, Peng SY, Lin JX, Li TY, Wang JP, Huang-MJ (2018) Accurate low ligation of inferior mesenteric artery and root lymph node dissection according to different vascular typing in laparoscopic radical resection of rectal cancer. Chin J Gastrointes Surg 21:46–52
47.
Han C, Shan X, Yao L, Yan P, Li M, Hu L, Tian H, Jing W, Du B, Wang L, Yang K, Guo T (2018) Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis. Surg Endosc 32:4377–4392CrossRefPubMed
48.
Murono K, Kawai K, Kazama S, Ishihara S, Yamaguchi H, Sunami E, Kitayama J, Watanabe T (2015) Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography. Dis Colon Rectum 58:214–219CrossRefPubMed
49.
Lange MM, Buunen M, van de Velde CJ, Lange JF (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review Dis Colon Rectum 51:1139–1145
50.
Hida J, Okuno K, Yasutomi M, Yoshifuji T, Uchida T, Tokoro T, Shiozaki H (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon Rectum 48:2232–2237CrossRefPubMed
51.
Hari DM, Leung AM, Lee JH, Sim MS, Vuong B, Chiu CG, Bilchik AJ (2013) AJCC cancer staging manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? J Am Coll Surg 217:181–190CrossRefPubMedPubMedCentral
52.
Grinnell RS, Hiatt RB (1952) Ligation of the interior mesenteric artery at the aorta in resections for carcinoma of the sigmoid and rectum. Surg Gynecol Obstet 94:526–534PubMed
53.
Dworkin MJ, Allen-Mersh TG (1996) Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg 183:357–360PubMed
54.
Yan P, Yao L, Li H, Zhang M, Xun Y, Li M, Cai H, Lu C, Hu L, Guo T, Liu R, Yang K (2018) The methodological quality of robotic surgical meta-analyses needed to be improved: a cross-sectional study. J Clin Epidemiol
55.
Bertrand MM, Delmond L, Mazars R, Ripoche J, Macri F, Prudhomme M (2014) Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches. Surg Radiol Anat: SRA 36:1057–1062CrossRefPubMed
Metadata
Title
Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis
Authors
Mou-Bo Si
Pei-Jing Yan
Zhen-Ying Du
Lai-Yuan Li
Hong-Wei Tian
Wen-Jie Jiang
Wu-Tang Jing
Jia Yang
Cai-Wen Han
Xiu-E Shi
Ke-Hu Yang
Tian-Kang Guo
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 6/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03291-5

Other articles of this Issue 6/2019

International Journal of Colorectal Disease 6/2019 Go to the issue

Original Article

Supplementation with Lactobacillus reuteri ATCC PTA 4659 in patients affected by acute uncomplicated diverticulitis: a randomized double-blind placebo controlled trial

Original Article

Characterization of risk factors for floppy pouch complex in ulcerative colitis

Original Article

Prognostic significance of C-reactive protein to albumin ratio in colorectal cancer patients: a meta-analysis

Original Article

Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction

Original Article

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

Original Article

Successful use of tissue expander and pelvic sling to exclude small bowel for high-dose pelvic irradiation