Analysis Of Lymph Node Metastasis Around The Root Of Inferior Mesenteric Vascular In Laparoscopic Radical Resection Of Colorectal Cancer

Purpose Laparoscopic radical resection of sigmoid and rectal cancerincludes ‘‘high tie’’ of the inferior mesenteric vascular(artery and vein). Byreviewing the clinical cases, the aim of this study was to analysis factorsaffecting the metastasis of lymph nodes(LN) around the IMA, and thesignificance of high tie of IMA and LN dissection in laparoscopic surgery.Methods Data on44consecutive patients who underwent laparoscopicresection of sigmoid and rectal cancer, with high tie of the IMA, were identifiedin China-Japan Union Hospital from September2011to February2012. Theclinical data were reviewed and analyzed. Special care should be taken not toinjure the hypogastric plexus during high ligation of the IMA. The regionallymph nodes around the root of inferior mesenteric vascular were specialmarked. The pathology analysis of lymph node metastasis and postoperativecomplications after laparoscopic surgery were studied for statistics andanalysis.Results There were2cases occurred the metastasis to the lymph nodessurrounding the origin of the inferior mesenteric artery after surgery, Theincidence was4.55percent, and there was no LN metastasis around the Inferiormesenteric vein(IMV). The rate of lymph nodes metastasis of tumor locatedupon the peritoneal reflection of rectal or sigmoid was52.4percent and58.3percent, and the rate of LN metastasis around IMA was4.76percent and8.33percent, but there was no metastasis to the IMA root on the tumor locatedbelow the peritoneal reflection; In the moderately and low differentiation groups, the LN metastasis rate was respectively55.6percent and71.4percent,two cases in moderately differentiation group appeared metastasis at the root ofIMA; The rate of lymph nodes metastasis of pT3and pT4tumor was68.0percent and85.7percent, and the rate of metastasis around the IMA root was4.0percent and14.3percent, and there was no LN metastasis to the IMA rooton pT1and pT2tumor. Anastomotic leakage wasn’t occurred in patients withrectal and colon first stage anastomosis. Postoperative patients were properlyunplugged urethral catheter, and there wasn’t increasing the risk of ejaculationdisorders and urinary incontinence in male.Conclusion1. The High tie of inferior mesenteric artery and lymph node dissectionshould be performed for the following risk factors: patients with tumor locatedupon the peritoneal reflection of rectal or sigmoid, low differentiated, pT3andpT4cancer.2. The technique of high ligation of the IMA can facilitate completemobilization of the left colon and fashioning of a tension-free anastomosis inlaparoscopic surgery, without increasing the occurrence of postoperativeanastomotic leakage.3. Due to amplification of laparoscopic and high-definition images, theautonomic nerve can be completely preserved, and there isn’t increasing therisk of ejaculation disorders and urinary incontinence.4. There were no lymph nodes metastasis around root of inferiormesenteric vein in our study. So the IMV could be ligated at the same level asIMA.