Vascular Anatomical Considerations and Its Relevance in Colon-Sigmoid and Rectal Surgery for Cancer: Personal Experience

Abstract
The ideal level of ligation of the inferior mesenteric artery (IMA) during curative resection of sigmoid and rectal cancer is still controversial. The aim of this retrospective review was to examine the impact of selective arterial ligation in relation non only to the vascular respect of the bowel but also the reduction of anastomotic leak in patients undergoing surgery for colon rectal cancer with IMA preservation.
Patients and Methods: We performed a cohort of 127 laparoscopic colosigmoid and rectal resections for cancer from January 2016 to December 2022 at Casa di Cura Bernardini Clinic. All patients underwent total colonoscopy with tattooing of the tumor. CT scan total body was performed with arteriographic study of the arterial vascular anatomy of IMA and its branches. 121 patients (95,2%) underwent laparoscopic procedure, 6 (4,7%) were converted to open surgery for adhesion syndrome and haemorrhage.
Results: Before hospital discharge, which took place on average after 8 days, all patients underwent radiological control of the anastomosis. Only one patient had an anastomotic laceration due to malfunction of the circular stapler during extraction. No patient presented clinical and/or radiological signs of anastomotic leak. There were no reports of postoperative death up to one month after surgery.
Conclusion: Low ligation of IMA during curative resection of sigmoid colon and rectal cancer appears to be associated with lower risk of anastomotic leakage and overall morbidity. Furthermore, the low ligation with preservation of left colic artery had similar limph node yeld although technically more demanding.