Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery.
OBJECTIVE
The aim of this study is to evaluate the influence of dividing the inferior mesenteric artery (IMA) and preserving the left colic artery (LCA) on rectosigmoid cancer surgery.


METHODS
Colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in 96 patients with cancer of the rectum and sigmoid colon while clamping IMA or LCA. Results were analyzed with patient characteristics and postoperative complications.


RESULTS
Blood flow was significantly decreased by either IMA or LCA clamping, and its reduction rate was 38.5 +/- 1.8%, ranged from 0 to 82.8%, or 16.4 +/- 1.8%, ranged from 0 to 66.2%, respectively. For multivariate analyses, aging and male gender were predictive factors of high blood flow reduction by IMA clamping. The reduction rate was significantly correlated with aging in male patients, while no such correlation was observed in women. Aging correlation in men was more significant in ultralow anterior resection cases. Three elderly male patients received IMA high ligation among 19 patients who demonstrated more than 50% blood flow reduction by IMA clamping. Among these, two patients, those who underwent ultralow anterior resection, suffered severe anastomotic ischemia.


CONCLUSIONS
Colonic blood flow at the proximal site of the anastomosis was significantly decreased by either IMA or LCA clamping. Patients with high reduction by IMA clamping need intraoperative efforts to prevent anastomotic ischemia, particularly in elderly male patients who undergo ultralow anterior resection.
Seike
Kazuhiro
K
Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan. kseike-cib@umin.ac.jp
Koda
Keiji
K
Saito
Norio
N
Oda
Kenji
K
Kosugi
Chihiro
C
Shimizu
Kimio
K
Miyazaki
Masaru
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008026:Ligation; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000503:physiopathology*; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000098:blood supply* / Q000601:surgery*; D012039:Regional Blood Flow; D012811:Sigmoid Neoplasms / Q000098:blood supply* / Q000601:surgery*; D013525:Surgical Instruments