Abstract
Purpose
It has been reported that some patients do not have an anastomosis of a marginal artery near the rectosigmoid junction, but the frequency of this condition and its clinical significance so far remain unclear. The aim of this study was to evaluate the blood flow at the marginal artery near the rectosigmoid junction.
Methods
From January 2013 to January 2014, we enrolled consecutive patients with a preoperative diagnosis of left-sided colon cancer or rectal cancer who underwent surgery with lymph node dissection. During the operation, the blood flow through the point of origin of the last sigmoid arterial branch, originating from the inferior mesenteric artery, was interrupted, and the rectosigmoid junction was supplied by only the marginal artery. We injected indocyanine green intravenously and observed the blood flow using a near-infrared camera system.
Results
A total of 119 consecutive patients were enrolled in this study. Sixty-eight patients (57.1 %) had a good anastomosis of the marginal artery near the rectosigmoid junction (type A). In 27 patients (22.7 %), a fluorescence border was recognized, but the fluorescence border diminished within 60 s (Type B). In 18 patients (15.1 %), delayed fluorescence was recognized over 60 s (type C), and 6 patients (5.0 %) had no fluorescence at all (type D). A mean length of 14.8 cm was found from the peritoneal reflection to fluorescence border of blood flow.
Conclusions
This study proves that cases without the anastomosis of the marginal artery of the rectosigmoid junction truly exist, using studies in living humans (UMIN000011186).
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References
Sudeck P (1907) Uber die gefassversorgung des mastdarmes in hinsicht auf die operative gangran. Munchen Med Wchnschr 54:1314
Griffiths J (1956) Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg Engl 19:241–256
Bacon H, Smith C (1918) The arterial supply of the distal colon pertinent to abdominoperineal proctosigmoidectomy, with preservation of the sphincter mechanism. Ann Surg 127:28
Pope C, Judd E (1929) The arterial blood supply of the sigmoid, rectosigmoid and rectum. Surg Clin North Am 9:957
Yamazaki T, Shirai Y, Sakai Y, Hatakeyama K (1997) Ischemic stricture of the rectosigmoid colon caused by division of the superior rectal artery below Sudeck’s point during sigmoidectomy: report of a case. Surg Today 27(3):254–256
van Tonder JJ, Boon JM, Becker JH, van Schoor AN (2007) Anatomical considerations on Sudeck’s critical point and its relevance to colorectal surgery. Clin Anat 20(4):424–427. doi:10.1002/ca.20417
Schaafsma BE, Mieog JS, Hutteman M, van der Vorst JR, Kuppen PJ, Lowik CW, Frangioni JV, van de Velde CJ, Vahrmeijer AL (2011) The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery. J Surg Oncol 104(3):323–332. doi:10.1002/jso.21943
Reuthebuch O, Haussler A, Genoni M, Tavakoli R, Odavic D, Kadner A, Turina M (2004) Novadaq SPY: intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest 125(2):418–424
Kang Y, Lee J, Kwon K, Choi C (2010) Dynamic fluorescence imaging of indocyanine green for reliable and sensitive diagnosis of peripheral vascular insufficiency. Microvasc Res 80(3):552–555. doi:10.1016/j.mvr.2010.07.004
Holm C, Dornseifer U, Sturtz G, Ninkovic M (2010) Sensitivity and specificity of ICG angiography in free flap reexploration. J Reconstr Microsurg 26(5):311–316. doi:10.1055/s-0030-1249314
Sekijima M, Tojimbara T, Sato S, Nakamura M, Kawase T, Kai K, Urashima Y, Nakajima I, Fuchinoue S, Teraoka S (2004) An intraoperative fluorescent imaging system in organ transplantation. Transplant Proc 36(7):2188–2190. doi:10.1016/j.transproceed.2004.09.001
Drummond H (1914) Some points relating to the surgical anatomy of the arterial supply of the large intestine. Proc R Soc Med 7:185–193
Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50(12):2223–2237. doi:10.1007/s10350-007-9051-0
Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Color Dis 23(7):703–707. doi:10.1007/s00384-008-0470-8
Cui Y, Chen H (2003) The effect of tension on esophagogastric anastomotic wound healing in rats. J Cardiovasc Surg 44(6):775–778
Attard JA, Raval MJ, Martin GR, Kolb J, Afrouzian M, Buie WD, Sigalet DL (2005) The effects of systemic hypoxia on colon anastomotic healing: an animal model. Dis Colon Rectum 48(7):1460–1470. doi:10.1007/s10350-005-0047-3
Shikata J, Shida T (1986) Effects of tension on local blood flow in experimental intestinal anastomoses. J Surg Res 40(2):105–111
Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43(1):76–82
Wilker D, Sklarek J, Waldner H, Izbicki JR, Siebeck M (1988) Early phase of healing of anastomoses with special reference to peritonitis and ischemia. Langenbecks Arch Chir 373(4):217–221
Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck’s Arch Surg Deut Ges Chir 395(8):1025–1030. doi:10.1007/s00423-010-0699-x
Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Color Dis 24(5):569–576. doi:10.1007/s00384-009-0658-6
Toens C, Krones CJ, Blum U, Fernandez V, Grommes J, Hoelzl F, Stumpf M, Klinge U, Schumpelick V (2006) Validation of IC-VIEW fluorescence videography in a rabbit model of mesenteric ischaemia and reperfusion. Int J Color Dis 21(4):332–338. doi:10.1007/s00384-005-0017-1
Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27(8):3003–3008. doi:10.1007/s00464-013-2832-8
Sherwinter DA, Gallagher J, Donkar T (2013) Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Colorectal disease : the officialJ Assoc Colopro Great Britain and Ireland 15(1):91–96. doi:10.1111/j.1463-1318.2012.03101.x
Fujii S, Yamamoto S, Ito M, Yamaguchi S, Sakamoto K, Kinugasa Y, Kokuba Y, Okuda J, Yoshimura K, Watanabe M (2012) Short-term outcomes of laparoscopic intersphincteric resection from a phase II trial to evaluate laparoscopic surgery for stage 0/I rectal cancer: Japan society of laparoscopic colorectal surgery Lap RC. Surg Endosc 26(11):3067–3076. doi:10.1007/s00464-012-2317-1
Shiomi A, Kinugasa Y, Yamaguchi T, Tomioka H, Kagawa H (2014) Robot-assisted rectal cancer surgery: short-term outcomes for 113 consecutive patients. Int J Color Dis 29(9):1105–1111. doi:10.1007/s00384-014-1921-z
Sung-Bum Kang JWP, Jeong S-Y, Nam BH, Choi HS, Kim D-W, Lim S-B, Lee T-G, Kim DY, Jae-Sung Kim HJC, Lee H-S, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Dae-Hyun Kim OJH (2014) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 15(7):767–774. doi:10.1016/s14702045(10)70131-5
van der Pas MHGM, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WCJ, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. doi:10.1016/s1470-2045(13)70016-0
Yamamoto S, Ito M, Okuda J, Fujii S, Yamaguchi S, Yoshimura K, Sugihara K, Watanabe M, Japan Society of Laparoscopic Colorectal S (2013) Laparoscopic surgery for stage 0/I rectal carcinoma: short-term outcomes of a single-arm phase II trial. Ann Surg 258(2):283–288. doi:10.1097/SLA.0b013e318283669c
Kwon YH, Jeon SW, Lee YK (2013) Endoscopic management of refractory benign colorectal strictures. Clin Endosc 46(5):472–475. doi:10.5946/ce.2013.46.5.472
Luchtefeld MA, Milsom JW, Senagore A, Surrell JA, Mazier WP (1989) Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership. Dis Colon Rectum 32(9):733–736
Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44(10):1464–1468
Anseline PF, Lavery IC, Fazio VW, Jagelman DG, Weakley FL (1981) Radiation injury of the rectum: evaluation of surgical treatment. Ann Surg 194(6):716–724
Hallbook O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83(1):60–62
Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P, Finan P (2006) Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study. Dis Colon Rectum 49(10):1611–1619. doi:10.1007/s10350-006-0663-6
MacRae HM, McLeod RS (1998) Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 41(2):180–189
Conflict of interest
Jun Watanabe, Mitsuyoshi Ota, Yusuke Suwa, Shinsuke Suzuki, Hirokazu Suwa, Masasi Momiyama, Atsushi Ishibe, Kazuteru Watanabe, Hidenobu Masui, Kaoru Nagahori, Yasushi Ichikawa and Itaru Endo have no conflicts of interest or financial ties to disclose.
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Watanabe, J., Ota, M., Suwa, Y. et al. Evaluation of the intestinal blood flow near the rectosigmoid junction using the indocyanine green fluorescence method in a colorectal cancer surgery. Int J Colorectal Dis 30, 329–335 (2015). https://doi.org/10.1007/s00384-015-2129-6
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DOI: https://doi.org/10.1007/s00384-015-2129-6