title: Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches.
abstract: OBJECTIVE
  Curative surgery is the standard treatment for colorectal cancer. The ligation level of the inferior mesenteric artery (IMA) is still debated, as neither low tie (LT) nor high tie ligation (HT) has shown any benefit on the patients' overall survival. We examined whether LT is standardizable and easily reproducible from an anatomical point of view.
  
  
  METHODS
  One hundred CT angiographies of healthy patients were analysed for the anatomy of the IMA and its division branches: left colic artery (LCA), sigmoid arteries trunk and superior rectal artery. Data analysed comprised angles between the IMA and the aorta, diameters of the IMA and its branches, repartition of the branches and distances between the origin of the branches and the origin of the IMA.
  
  
  RESULTS
  IMA anatomy showed no variation. In contrast, its division branches showed important variability in terms of distance to the origin and repartition: in 19.9% of the patients, the IMA directly splits into three branches, and in 17.6% of the patients, the LCA originated at more than 5 cm from the origin of the IMA. These frequent variations led us to assume that the standardization of LT is very difficult in a context of neoplasm, where the quality of the lymphadenectomy is fundamental.
  
  
  CONCLUSIONS
  The division branches of the IMA are extremely subject to interindividual variations, making it difficult if not impossible to reproduce identically a surgical procedure based on their anatomy. HT appears to us as the only relevant procedure for colorectal cancer.
authors.affiliation: Laboratory of Experimental Anatomy, Faculty of Medicine Montpellier-Nîmes, University Montpellier I, 30 rue Lunaret, 34090, Montpellier, France, martinmbertrand@yahoo.fr.
authors.forename: M M
authors.initials: MM
authors.lastname: Bertrand
authors.forename: L
authors.initials: L
authors.lastname: Delmond
authors.forename: R
authors.initials: R
authors.lastname: Mazars
authors.forename: J
authors.initials: J
authors.lastname: Ripoche
authors.forename: F
authors.initials: F
authors.lastname: Macri
authors.forename: M
authors.initials: M
authors.lastname: Prudhomme
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007479:Iopamidol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol