title: Are there any surgical and radiological correlations to the level of ligation of the inferior mesenteric artery after sigmoidectomy for cancer?
abstract: BACKGROUND
  The Société Française de Chirurgie Digestive and the American Society of Colon and Rectal Surgeons recommend a ligation at the origin of the primary feeding vessel for sigmoid cancer to ensure optimal lymphadenectomy. We evaluated the correlation between the level of ligation defined by the surgeon and the real level of ligation visualized on postoperative CT scan.
  
  
  METHODS
  From December 2004 to August 2010, in a series of 146 patients undergoing colectomy for sigmoid cancer, 51 (19 women) CT measurements (visualization of the left colonic artery (LCA), length of the arterial stump) were performed by a radiologist blinded to operative data.
  
  
  RESULTS
  This series comprised 63% of men with a mean age of 69 years. A correlation was demonstrated between the level of ligation assessed by the surgeon and the real level of ligation demonstrated on postoperative CT scan in 41% of cases. No risk factors for absence of correlation were identified (laparoscopy, gender, BMI, emergency, and ASA score). In the "no correlation" group, the site of ligation was overestimated in 70% of cases. No significant difference was observed between the "correlation" and "no correlation" groups for lymphadenectomy (21.6 and 18 lymph nodes, p=0.5593) or 5-year overall survival (71.4 and 93.1 months, p=0.57).
  
  
  CONCLUSIONS
  In conclusion, the surgical and radiological correlations are low as the intraoperative estimation of the level of IMA ligation was correlated with CT findings in less than 50% of cases. No risk factors for non-correlation were identified, and there was no impact on lymphadenectomy. Overestimation of the level of ligation was the most frequent situation but did not appear to have any impact on tumor staging or on patient management in this group of patients.
authors.affiliation: Department of Digestive and Metabolic Surgery, North University Hospital Centre of Amiens, Place Victor Pauchet, 80054 Amiens Cedex, France; University of Picardie Jules Verne, Amiens, France.
authors.forename: Flavien
authors.initials: F
authors.lastname: Prevot
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Deguines
authors.forename: Arnaud
authors.initials: A
authors.lastname: Potier
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D016208:Databases, Factual; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008026:Ligation; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D019300:Medical Errors; D017537:Mesenteric Artery, Inferior / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*; D011786:Quality Control; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Inferior mesenteric artery; Level of ligation; Sigmoid cancer; Sigmoidectomy