The Surgical Technique of Laparoscopic Lymph Node Dissection Around the Inferior Mesenteric Artery with Preservation of Superior Rectal Artery and Vein for Treatment of the Sigmoid and Rectal Cancer.

BACKGROUND

The inferior mesenteric artery (IMA) is usually divided during the resection of sigmoid colon and rectal cancers. However, this sometimes results in a vein (SRA\V) insufficient blood supply to the anastomosis, leading to anastomotic leakage. We summarized the experience of laparoscopy surgery approach to perform the D3 lymph node dissection with preserving the superior rectal artery and vein.

METHODS

Our method involves peeling off the vascular sheath from the inferior mesenteric vessel to the superior rectal vessel and dissection of the lymph node around the IMA together with the sheath. The feasibility outcomes of the technique were evaluated in 36 cases of laparoscopic resection of sigmoid and rectal cancer.

RESULTS

Our method involves peeling off the vascular sheath from the inferior mesenteric vessel to the superior rectal vessel and dissection of the lymph node around the IMA together with the sheath. The feasibility of the technique was evaluated in 36 consecutive cases of laparoscopic resection of sigmoid and rectal cancer. Patients with sigmoid or rectal cancer underwent operation via the present laparoscopic approach. No serious complications related to the approach were encountered. The number of cleared lymph nodes was 17 (range 10-35). The operation time was 200 (range 160-300) minutes. The blood loss was 50 (range 20-100) mL. Anastomotic leakage never occurred in these patients without preoperative chemoradiation therapy, the patients had quick convalescence, as evaluated by the recovery of flatus passage (2.8 ± 1.5 days), postoperative hospitalization (10.8 ± 4.6 days), degree of postoperative pain for 48 hours (2.5 ± 0.5, visual analog scale), duration of postoperative ambulation (1.5 ± 0.5 days), and drainage tube removal time (1.0 ± 0.4 days).

CONCLUSION

Our method allows equivalent laparoscopic lymph node dissection to the preservation of the SRA\V technique without excessive operative time, complications, or bleeding. It seems to be a promising and feasible technique for these patients with sigmoid and rectal cancer.