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Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aims

The aim of this study is to evaluate the influence of dividing the inferior mesenteric artery (IMA) and preserving the left colic artery (LCA) on rectosigmoid cancer surgery.

Patients and methods

Colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in 96 patients with cancer of the rectum and sigmoid colon while clamping IMA or LCA. Results were analyzed with patient characteristics and postoperative complications.

Results

Blood flow was significantly decreased by either IMA or LCA clamping, and its reduction rate was 38.5 ± 1.8%, ranged from 0 to 82.8%, or 16.4 ± 1.8%, ranged from 0 to 66.2%, respectively. For multivariate analyses, aging and male gender were predictive factors of high blood flow reduction by IMA clamping. The reduction rate was significantly correlated with aging in male patients, while no such correlation was observed in women. Aging correlation in men was more significant in ultralow anterior resection cases. Three elderly male patients received IMA high ligation among 19 patients who demonstrated more than 50% blood flow reduction by IMA clamping. Among these, two patients, those who underwent ultralow anterior resection, suffered severe anastomotic ischemia.

Conclusions

Colonic blood flow at the proximal site of the anastomosis was significantly decreased by either IMA or LCA clamping. Patients with high reduction by IMA clamping need intraoperative efforts to prevent anastomotic ischemia, particularly in elderly male patients who undergo ultralow anterior resection.

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Authors and Affiliations

  1. Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan

    Kazuhiro Seike, Keiji Koda, Kenji Oda, Chihiro Kosugi, Kimio Shimizu & Masaru Miyazaki

  2. Colorectal Surgery Division, The Department of Surgical Oncology, National Cancer Centre, Hospital East, Kashiwa, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan

    Norio Saito

Authors
  1. Kazuhiro Seike
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  2. Keiji Koda
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  3. Norio Saito
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  4. Kenji Oda
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  5. Chihiro Kosugi
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  6. Kimio Shimizu
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  7. Masaru Miyazaki
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Correspondence to Kazuhiro Seike.

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Seike, K., Koda, K., Saito, N. et al. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis 22, 689–697 (2007). https://doi.org/10.1007/s00384-006-0221-7

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  • DOI: https://doi.org/10.1007/s00384-006-0221-7

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