Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery
Objectives: Left colic artery preserving lymph node dissection around the inferior mesenteric artery (IMA) is a standard procedure for rectal cancer surgery. Although the IMA sheath is a well-known structure, to our knowledge, there are no reports describing its microanatomy from an oncological poin...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The Japan Society of Coloproctology
2019-10-01
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| Series: | Journal of the Anus, Rectum and Colon |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/jarc/3/4/3_2019-016/_pdf/-char/en |
| _version_ | 1818192245250064384 |
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| author | Wataru Sakamoto Leo Yamada Osamu Suzuki Tomohiro Kikuchi Hirokazu Okayama Hisahito Endo Shotaro Fujita Motonobu Saito Tomoyuki Momma Zenichiro Saze Shinji Ohki Koji Kono |
| author_facet | Wataru Sakamoto Leo Yamada Osamu Suzuki Tomohiro Kikuchi Hirokazu Okayama Hisahito Endo Shotaro Fujita Motonobu Saito Tomoyuki Momma Zenichiro Saze Shinji Ohki Koji Kono |
| author_sort | Wataru Sakamoto |
| collection | DOAJ |
| description | Objectives: Left colic artery preserving lymph node dissection around the inferior mesenteric artery (IMA) is a standard procedure for rectal cancer surgery. Although the IMA sheath is a well-known structure, to our knowledge, there are no reports describing its microanatomy from an oncological point of view; therefore, there is no consensus on how to handle the sheath for accurate lymph node dissection around IMA. We aimed to investigate the components of the IMA sheath pathologically, focusing particularly on the presence of lymph nodes (LNs) and lymphatic ducts (LDs). Methods: We evaluated rectal and sigmoid cancer specimens resected with high-tie technique in our institute in April 2017-April 2018. The specimens were collected consecutively, without any selection. In the resected specimens, the entire anatomical structure of IMA was investigated. We defined the IMA sheath as the tissues located between the surface of the IMA adventitia and collagenous layers connecting the outermost nerve fibers. The microanatomy around the IMA was examined using H&E staining, and LDs were identified using D2-40 immunohistochemistry. Results: Twenty patients were enrolled. No LNs were observed within the sheath in any of the cases. However, there were a significant number of LDs (11.08 ± 3.35) within the sheath. Conclusions: Our anatomical definition of IMA sheath was feasible and objectively possible. These microanatomical results partially support the surgical concept of left colic artery preserving lymph node dissection around the IMA. It may be difficult to remove all lymphatic ducts without removing the IMA itself. |
| first_indexed | 2024-12-12T00:27:26Z |
| format | Article |
| id | doaj.art-7a72dae9d5eb413eb839b4713b6e6af7 |
| institution | Directory Open Access Journal |
| issn | 2432-3853 |
| language | English |
| last_indexed | 2024-12-12T00:27:26Z |
| publishDate | 2019-10-01 |
| publisher | The Japan Society of Coloproctology |
| record_format | Article |
| series | Journal of the Anus, Rectum and Colon |
| spelling | doaj.art-7a72dae9d5eb413eb839b4713b6e6af72022-12-22T00:44:34ZengThe Japan Society of ColoproctologyJournal of the Anus, Rectum and Colon2432-38532019-10-013416717410.23922/jarc.2019-0162019-016Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgeryWataru Sakamoto0Leo Yamada1Osamu Suzuki2Tomohiro Kikuchi3Hirokazu Okayama4Hisahito Endo5Shotaro Fujita6Motonobu Saito7Tomoyuki Momma8Zenichiro Saze9Shinji Ohki10Koji Kono11Department of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Diagnostic Pathology, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityDepartment of Gastrointestinal Tract Surgery, School of Medicine, Fukushima Medical UniversityObjectives: Left colic artery preserving lymph node dissection around the inferior mesenteric artery (IMA) is a standard procedure for rectal cancer surgery. Although the IMA sheath is a well-known structure, to our knowledge, there are no reports describing its microanatomy from an oncological point of view; therefore, there is no consensus on how to handle the sheath for accurate lymph node dissection around IMA. We aimed to investigate the components of the IMA sheath pathologically, focusing particularly on the presence of lymph nodes (LNs) and lymphatic ducts (LDs). Methods: We evaluated rectal and sigmoid cancer specimens resected with high-tie technique in our institute in April 2017-April 2018. The specimens were collected consecutively, without any selection. In the resected specimens, the entire anatomical structure of IMA was investigated. We defined the IMA sheath as the tissues located between the surface of the IMA adventitia and collagenous layers connecting the outermost nerve fibers. The microanatomy around the IMA was examined using H&E staining, and LDs were identified using D2-40 immunohistochemistry. Results: Twenty patients were enrolled. No LNs were observed within the sheath in any of the cases. However, there were a significant number of LDs (11.08 ± 3.35) within the sheath. Conclusions: Our anatomical definition of IMA sheath was feasible and objectively possible. These microanatomical results partially support the surgical concept of left colic artery preserving lymph node dissection around the IMA. It may be difficult to remove all lymphatic ducts without removing the IMA itself.https://www.jstage.jst.go.jp/article/jarc/3/4/3_2019-016/_pdf/-char/eninferior mesenteric arterylow-tie with lymph node dissectionleft colic arterycolorectal cancerlymph node dissection |
| spellingShingle | Wataru Sakamoto Leo Yamada Osamu Suzuki Tomohiro Kikuchi Hirokazu Okayama Hisahito Endo Shotaro Fujita Motonobu Saito Tomoyuki Momma Zenichiro Saze Shinji Ohki Koji Kono Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery Journal of the Anus, Rectum and Colon inferior mesenteric artery low-tie with lymph node dissection left colic artery colorectal cancer lymph node dissection |
| title | Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| title_full | Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| title_fullStr | Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| title_full_unstemmed | Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| title_short | Microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| title_sort | microanatomy of inferior mesenteric artery sheath in colorectal cancer surgery |
| topic | inferior mesenteric artery low-tie with lymph node dissection left colic artery colorectal cancer lymph node dissection |
| url | https://www.jstage.jst.go.jp/article/jarc/3/4/3_2019-016/_pdf/-char/en |
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