Influence of prophylactic apical node dissection of the inferior mesenteric artery on prognosis of colorectal cancer.
OBJECTIVE
Middle ligation (ML) of the inferior mesenteric artery (IMA) maintains adequate blood supply to an anastomosis and has no risk of autonomic nerve injury. If apical node dissection of the IMA improves the prognosis, ML and prophylactic dissection of the apical node without division of the IMA above the colic artery may also result in an additional prognostic improvement in patients with sigmoid colon or rectal cancer.


METHODS
Four hundred and one patients with either Dukes' B or Dukes' C colorectal cancer were clinicopathologically examined. In order to evaluate the influence of the prophylactic dissection of the apical node on the prognosis, the two groups of ML with and without apical node dissection were compared.


RESULTS
The 5-year survival rates in the groups of ML and ML with apical node dissection were 90% and 91%, respectively, in 218 Dukes' B patients. The 5-year survival rates in the groups of ML and ML with apical node dissection were 73% and 71%, respectively, in 183 Dukes' C patients. There were no significant differences between the two groups in both Dukes' B and Dukes' C patients.


CONCLUSIONS
When ML is adopted for patients with sigmoid colon or rectal cancer, additional dissection of the apical node is not needed.
Ikeda
Yoichi
Y
Department of Surgery, National Kyushu Medical Center, Chuo-ku, Fukuoka, 810-8563 Japan. yoikeda@qmed.hosp.go.jp
Shimabukuro
Rinshun
R
Saitsu
Hideki
H
Saku
Motonori
M
Maehara
Yoshihiko
Y
D000368:Aged; D005260:Female; D006801:Humans; D008026:Ligation; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis