title: Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery.
abstract: 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.
authors.affiliation: 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
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Seike
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
authors.forename: Kenji
authors.initials: K
authors.lastname: Oda
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.forename: Kimio
authors.initials: K
authors.lastname: Shimizu
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: 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