The Impact Of High Tie Vs. Low Tie Of IMA Identified With MDCT On No.253 Lymphadenectomy And Post-operative Recovery Of Rectosigmoid Cancer Patients

ObjectiveTo evaluate the difference of No.253 lymphadenectomy and post-operative recovery of rectosigmoid cancer patients between high tie and low tie of IMA identified with MDCT.MethodsWe performed a retrospective study of clinical data of 120 patients who underwent rectal cancer surgery and 60 patients who underwent sigmoid cancer surgery at the 2nd Affiliated Hospital of Soochow University from June 2010 to June 2015. Through comparing the medical records, pre-operative and post-operative CT, we classified the patients into the high tie group and low tie group. The excision of the lymph nodes around the root of IMA(No.253), operative information and post-operative complications between the two groups were collected and analyzed.ResultsAll operations were completed successfully. Through comparing pre-operation and post-operation enhanced MDCT, 82 cases were performed by high ligation of IMA and 98 by low ligation. LN1 was(0.06±0.25) in high tie group and(0.08±0.27) in low tie group,without showing any significant difference(P>0.05). LN2 was 0 in high tie group and(0.01±0.11) in low tie group, without showing any significant difference(P>0.05) Duration of operations was(149.87±23.28) min in high group and(143.97±20.02) min in low tie group,without showing any significant difference(P>0.05). Postoperation hospital stay was(12.48±3.86) d in high tie group and(11.12±3.95) d in low tie group, without showing any significant difference(P>0.05).As to post-operative complications, the anastomotic leak rate was 8.5% in high tie group and 1.0% in low tie group, which showed a higher rate of anastomotic leak in high tie group(P<0.05). Otherwise, There were no significant differences in post-operative hemorrhage(1.2% in high tie group vs. 3.1% in low tie group), stoma necrosis rates(1.2%vs. 0%), and urinary retention incidence(6.1% vs. 3.1%) between the two groups.ConclusionFor rectosigmoid cancer, there were no significant differences in lymph node dissection degree, operation time and post-operative recovery time between IMA high ligation and low ligation judged by MDCT. There were also no significant differences in post-operative hemorrhage, stoma necrosis, and urinary retention incidence between the two groups. But high tie of IMA showed a higher incidence of anastomotic leak than low tie.