title: High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit.
abstract: During surgery for colorectal cancer, the inferior mesenteric artery (IMA) may be ligated either directly at the origin of the IMA from the aorta (high ligation) or at a point just below the origin of the left colic artery (low ligation). Sixty patients of left colonic and rectal cancer undergoing elective curative surgery in 2007 and 2008 were selected for this observational study. The resected lymph nodes were grouped into three levels: along the bowel wall (D1), along IMA below left colic (D2), and along the IMA and its root (D3). Statistical analysis was performed with SPSS version 20.0. D2 level was involved pathologically in 20 (33.3 %) and D3 in six out of 44 (13.6 %) patients. The median nodal yield with high and low ligation were 33 and 25, respectively (p = 0.048). Median overall survival for high ligation was 62 months versus 42 months for low ligation (p = 0.190). High ligation of the IMA for rectal and left colonic cancers can improve lymph node yield, thus facilitating accurate tumor staging and thus better disease prognostication, but the survival benefit is not significant.
authors.affiliation: Department of Surgery, Sardar Patel Medical College, Bikaner, Rajasthan India.
authors.forename: Ishwar
authors.initials: I
authors.lastname: Charan
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Mukesh Kumar
authors.initials: MK
authors.lastname: Singhal
authors.affiliation: Department of Radiology, BJ Medical College, Ahmedabad, Gujarat India.
authors.forename: Namrata
authors.initials: N
authors.lastname: Jagawat
authors.affiliation: Department of Surgery, Sardar Patel Medical College, Bikaner, Rajasthan India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhavsar
authors.affiliation: Department of Surgery, Apollo Hospitals, Madurai, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Jain
authors.affiliation: Department of Pathology, Sardar Patel Medical College, Bikaner, Rajasthan India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
authors.forename: Harvindra Singh
authors.initials: HS
authors.lastname: Kumar
keywords: High ligation; Inferior mesenteric artery; Left colon; Low ligation; Rectal cancer; Survival benefit