Selective approach to arterial ligation in radical sigmoid colon cancer surgery with D3 lymph node dissection: A multicenter comparative study
1Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
2Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Türkiye
3Clinic of Gastrointestinal Surgery, İnönü University Hospital, Malatya, Türkiye
Objective: Radical surgery for sigmoid colon cancer is commonly performed with complete mesocolic excision (CME) and apical lymph node dissection, reached by central vascular ligation (CVL) of the inferior mesenteric artery (IMA) and associated extended left colon resection. However, IMA branches can be ligated selectively according to tumor location with D3 lymph node dissection (LND), economic segmental colon resection and tumorspecific mesocolon excision (TSME) if IMA is skeletonized. This study aimed to compare left hemicolectomy with CME and CVL and segmental colon resection with selective vascular ligation (SVL) and D3 LND.
Material and Methods: Patients (n= 217) treated with D3 LND for adenocarcinoma of the sigmoid colon between January 2013 and January 2020 were included in the study. The approach to vessel ligation, colon resection and mesocolon excision was based on tumor location in the study group, while in the comparison group, left hemicolectomy with routine CVL was performed. Survival rates were estimated as the primary endpoints of the study. Long- and short-term surgery-related outcomes were evaluated as the secondary endpoints of the study.
Results: The studied approach to the IMA branch ligation was associated with a statistically significant decrease in intraoperative complication rates (2 vs 4, p= 0.024), operative procedure length (225.56 ± 80.356 vs 330.69 ± 175.488, p< 0.001), and severe postoperative morbidity (6.2% vs 19.1%, p= 0.017). Meanwhile, the number of examined lymph nodes significantly increased (35.67 vs 26.69 per specimen, p< 0.001). There were no statistically significant differences in survival rates.
Conclusion: Selective IMA branch ligation and TSME resulted in better intraoperative and postoperative outcomes with no difference in survival rates.
Keywords: Colon cancer, complete mesocolon excision, D3 lymph node dissection, central vascular ligation, inferior mesenteric artery, sigmoid colon
Cite this article as: Efetov S, Zubayraeva A, Kayaalp C, Minenkova A, Bağ Y, Alekberzade A, et al. Selective approach to arterial ligation in radical sigmoid colon cancer surgery with D3 lymph node dissection: A multicenter comparative study. Turk J Surg 2022; 38 (4): 382-390.
This study was approved by Sechenov University Institutional Review Board (Registration no: SU300585, Date: 08.08.2022).
Concept – SE, AZ, PT; Design – SE, AZ; Supervision – SE, PT; Fundings – SE, CK; Materials – SE, CK, PT; Data Collection and/ or Processing – AZ, AM, AA, YB; Analysis and/or Interpretation – AZ, SE, AM; Literature Search – AZ; Writing Manuscript – AZ, SE; Critical Reviews – AZ, SE, CK.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.