title: Resection of Colorectal Cancer With Versus Without Preservation of Inferior Mesenteric Artery.
abstract: OBJECTIVE
  To assess the clinical significance of preservation of the inferior mesenteric artery (IMA) in comparison with IMA ligation in surgery for sigmoid colon or rectal (colorectal) cancer.
  
  
  METHODS
  Consecutive patients (n=862) with colorectal cancer who underwent intended surgical resection of the main tumor between 1986 and 2011 were retrospectively analyzed. The patients were divided into 2 groups: IMA preserved (n=745) and IMA ligated (n=117).
  
  
  RESULTS
  No significant difference was observed in incidence of advanced stage III or IV disease between the 2 groups (P=0.56 and 0.51, respectively), whereas a longer operation time (287 [95 to 700] vs. 215 [60 to 900] min, respectively; P<0.001) and greater amount of intraoperative bleeding (595 [15 to 4530] vs. 235 [1 to 11565] mL, respectively; P<0.001) were observed in the IMA-ligated group. The overall incidence of surgery-related complications was higher in the IMA-ligated group than in the IMA-preserved group (53.0% vs. 38.5%, respectively; P=0.003). Urinary dysfunction and abdominal abscess were significantly more frequent in the IMA-ligated group (11.1% vs. 4.0%, P=0.001; and 6.8% vs. 2.6%, P=0.01, respectively), and postoperative hospitalization was longer (11 to 140, median 28 vs. 5 to 153, median 19 d, respectively; P<0.001). No significant difference was found in overall survival rate between the 2 groups.
  
  
  CONCLUSIONS
  For colorectal cancer resection, IMA preservation may be no change to IMA ligation as to patient' survival, with small risk of operative morbidity.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mihara
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Kochi
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujii
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kanamori
authors.forename: Tomoya
authors.initials: T
authors.lastname: Funada
authors.forename: Youichi
authors.initials: Y
authors.lastname: Teshima
authors.forename: Daijo
authors.initials: D
authors.lastname: Jinno
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged; D009926:Organ Preservation; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome