High Versus Low Ligation of the Inferior Mesenteric Artery During Rectal Resection for Cancer: Oncological Outcomes After Three Years of Follow-Up From the HIGHLOW Trial.
disease-free survival
disease-specific survival
inferior mesenteric artery
laparoscopic surgery
low ligation
rectal cancer
Journal
Annals of surgery open : perspectives of surgical history, education, and clinical approaches
ISSN: 2691-3593
Titre abrégé: Ann Surg Open
Pays: United States
ID NLM: 101769928
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
28
07
2020
accepted:
03
09
2020
medline:
19
10
2020
pubmed:
19
10
2020
entrez:
28
8
2023
Statut:
epublish
Résumé
To determine the disease-free survival (DFS), disease-specific survival (DSS), and recurrence in patients who underwent laparoscopic low anterior rectal resection with total mesorectal excision (TME) with either high or low ligation of the inferior mesenteric artery (IMA). The level of IMA ligation during anterior rectal resection with TME is still a matter of debate, especially in terms of oncological adequacy. Between June 2014 and December 2016, patients scheduled to undergo elective laparoscopic low anterior resection (LAR) and TME in 6 Italian nonacademic hospitals were randomized into 2 groups in the HIGHLOW Trial (ClinicalTrials.gov Identifier: NCT02153801) according to the level of IMA ligation: high ligation (HL) versus low ligation (LL). DFS, DSS, and recurrence were inquired. Recurrence was determined at 3, 6, 9, and 12 months and every 6 months thereafter. Patients and tumor characteristics as well as surgical outcomes were analyzed to identify risk factors for recurrence. One hundred ninety-six patients from the HIGHLOW trial were analyzed. Median follow-up for DFS was 40.6 (interquartile range [IQR], 6-64.7) and 40 (IQR, 7.6-67.8), while median follow-up for DSS was 41.2 (IQR, 10.7-64.7) and 42.7 (IQR, 6-67.6) in the HL and LL groups, respectively. The 3-year DFS rate of HL and LL patients was 82.2% and 82.1% ( The level of inferior mesenteric artery ligation during LAR and TME for rectal cancer does not affect DFS, DSS, and recurrence.
Sections du résumé
Objectives
UNASSIGNED
To determine the disease-free survival (DFS), disease-specific survival (DSS), and recurrence in patients who underwent laparoscopic low anterior rectal resection with total mesorectal excision (TME) with either high or low ligation of the inferior mesenteric artery (IMA).
Background
UNASSIGNED
The level of IMA ligation during anterior rectal resection with TME is still a matter of debate, especially in terms of oncological adequacy.
Methods
UNASSIGNED
Between June 2014 and December 2016, patients scheduled to undergo elective laparoscopic low anterior resection (LAR) and TME in 6 Italian nonacademic hospitals were randomized into 2 groups in the HIGHLOW Trial (ClinicalTrials.gov Identifier: NCT02153801) according to the level of IMA ligation: high ligation (HL) versus low ligation (LL). DFS, DSS, and recurrence were inquired. Recurrence was determined at 3, 6, 9, and 12 months and every 6 months thereafter. Patients and tumor characteristics as well as surgical outcomes were analyzed to identify risk factors for recurrence.
Results
UNASSIGNED
One hundred ninety-six patients from the HIGHLOW trial were analyzed. Median follow-up for DFS was 40.6 (interquartile range [IQR], 6-64.7) and 40 (IQR, 7.6-67.8), while median follow-up for DSS was 41.2 (IQR, 10.7-64.7) and 42.7 (IQR, 6-67.6) in the HL and LL groups, respectively. The 3-year DFS rate of HL and LL patients was 82.2% and 82.1% (
Conclusions
UNASSIGNED
The level of inferior mesenteric artery ligation during LAR and TME for rectal cancer does not affect DFS, DSS, and recurrence.
Identifiants
pubmed: 37637440
doi: 10.1097/AS9.0000000000000017
pmc: PMC10455194
doi:
Banques de données
ClinicalTrials.gov
['NCT02153801']
Types de publication
Journal Article
Langues
eng
Pagination
e017Informations de copyright
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Disclosure: The authors declare that they have nothing to disclose. This article was not based on a previous communication to a society or meeting. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Références
Ann Surg. 2019 Apr;269(4):596-602
pubmed: 30247332
Dis Colon Rectum. 1994 Jul;37(7):651-9
pubmed: 8026230
Dis Colon Rectum. 2012 May;55(5):515-21
pubmed: 22513429
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Nov;18(11):1132-5
pubmed: 26616809
Ann Surg. 2019 Apr;269(4):589-595
pubmed: 30080730
Br J Surg. 2006 May;93(5):609-15
pubmed: 16607682
Int J Surg. 2018 Apr;52:20-24
pubmed: 29432970
Lancet. 1986 Nov 1;2(8514):996-9
pubmed: 2430152
Trials. 2015 Jan 27;16:21
pubmed: 25623323
Ann Surg. 1984 Dec;200(6):729-33
pubmed: 6508403
Dig Surg. 2007;24(5):375-81
pubmed: 17785983
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
Dig Surg. 2008;25(2):148-57
pubmed: 18446037
Surg Oncol. 2011 Dec;20(4):e149-55
pubmed: 21632237
Anticancer Res. 2019 Aug;39(8):4363-4370
pubmed: 31366531
BJS Open. 2018 Jun 08;2(4):195-202
pubmed: 30079388
Ann Coloproctol. 2019 Aug;35(4):167-173
pubmed: 31487763
Gastrointest Tumors. 2017 Sep;4(1-2):45-52
pubmed: 29071264
Surg Endosc. 2008 May;22(5):1278-82
pubmed: 17943355
Dis Colon Rectum. 1997 Oct;40(10):1205-18; discussion 1218-9
pubmed: 9336116
J BUON. 2018 Sep-Oct;23(5):1350-1361
pubmed: 30570858
Medicine (Baltimore). 2017 Nov;96(47):e8520
pubmed: 29381926
J Laparoendosc Adv Surg Tech A. 2018 Feb;28(2):117-126
pubmed: 28570140
Br J Surg. 2015 Apr;102(5):501-8
pubmed: 25764287
Ann Surg. 2019 Jun;269(6):1018-1024
pubmed: 31082897