TY - JOUR
T1 - Level of arterial ligation in rectal cancer surgery
T2 - Low tie preferred over high tie. A review
AU - Lange, Marilyne M.
AU - Buunen, Mark
AU - Van De Velde, Cornelis J.H.
AU - Lange, Johan F.
PY - 2008/7
Y1 - 2008/7
N2 - Consensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just caudally to the origin of the left colic artery (low tie), and ligation at a level without any intraoperative definition of the inferior mesenteric or superior rectal arteries. Publications concerning the level of ligation in rectal cancer surgery were systematically reviewed. Twenty-three articles that evaluated oncologic outcome (n=14), anastomotic circulation (n=5), autonomous innervation (n=5), and tension on the anastomosis/anastomotic leakage (n=2) matched our selection criteria and were systematically reviewed. There is insufficient evidence to support high tie as the technique of choice. Furthermore, high tie has been proven to decrease perfusion and innervation of the proximal limb. It is concluded that neither the high tie strategy nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. As a consequence, in rectal cancer surgery low tie should be the preferred method.
AB - Consensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just caudally to the origin of the left colic artery (low tie), and ligation at a level without any intraoperative definition of the inferior mesenteric or superior rectal arteries. Publications concerning the level of ligation in rectal cancer surgery were systematically reviewed. Twenty-three articles that evaluated oncologic outcome (n=14), anastomotic circulation (n=5), autonomous innervation (n=5), and tension on the anastomosis/anastomotic leakage (n=2) matched our selection criteria and were systematically reviewed. There is insufficient evidence to support high tie as the technique of choice. Furthermore, high tie has been proven to decrease perfusion and innervation of the proximal limb. It is concluded that neither the high tie strategy nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. As a consequence, in rectal cancer surgery low tie should be the preferred method.
KW - Central arterial ligation
KW - High tie
KW - Inferior mesenteric artery
KW - Low tie
KW - Rectal cancer
KW - Total mesorectal excision
UR - http://www.scopus.com/inward/record.url?scp=46649108315&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10350-008-9328-y
DO - https://doi.org/10.1007/s10350-008-9328-y
M3 - Review article
C2 - 18483828
SN - 0012-3706
VL - 51
SP - 1139
EP - 1145
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 7
ER -