title: Clinical and surgical aspects of high and low ligation of inferior mesenteric artery in laparoscopic resection for advanced colorectal cancer in elderly patients.
abstract: OBJECTIVE
  Objective of the present study was the evaluation of the efficacy of the low ligation of the inferior mesenteric artery with lymphadenectomy at the root in rectosigmoid resection for advanced cancer by laparoscopic approach.
  
  
  METHODS
  Ninety-two elderly patients with stage III tumors were retrospectively divided into three groups: low ligation of inferior mesenteric artery with and without lymphadenectomy at its root and high ligation. Anastomotic fistula, lymph nodes harvested and oncologic outcome were examined.
  
  
  RESULTS
  Significant differences were registered in the number of lymph nodes comparing high and low ligation with lymphadenectomy to simple low ligation. Only 8.3% of patients treated by lymphadenectomy had metastasis at the root of mesenteric artery. Not significant shorter operative time was observed in the high compared to low ligation. Significantly longer time was observed in low ligation when it was associated to lymphadenectomy. Not significant difference was observed in term of anastomotic leakage. Significant increase in cancer related deaths was observed in the low ligation group without lymphadenectomy. Not significant difference in morbidity was observed in the different groups.
  
  
  CONCLUSIONS
  Low ligation of the inferior mesenteric artery with lymphadenectomy is a safe and effective procedure in the treatment of advanced rectosigmoid cancer with similar results compared to high ligation. It might be especially indicated in elderly patients with advanced tumors to better define lymph nodes involvement and to improve vascular flow to the anastomosis.
authors.affiliation: Department of Surgery "Pietro Valdoni" La Sapienza University, Rome, Italy - giorgio.detoma@uniroma1.it.
authors.forename: A
authors.initials: A
authors.lastname: Polistena
authors.forename: G
authors.initials: G
authors.lastname: Cavallaro
authors.forename: G
authors.initials: G
authors.lastname: D'Ermo
authors.forename: A
authors.initials: A
authors.lastname: Paliotta
authors.forename: D
authors.initials: D
authors.lastname: Crocetti
authors.forename: L
authors.initials: L
authors.lastname: Rosato
authors.forename: G
authors.initials: G
authors.lastname: De Toma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008026:Ligation / Q000379:methods; D008197:Lymph Node Excision; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies