Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2020; 26(24): 3484-3494
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3484
Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Chao Zhang, Ang Li, Tao Luo, Yu Li, Fei Li, Jia Li, Gastroenteropancreatic Center, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
Author contributions: Zhang C and Li A are co-first authors; Zhang C, Li A, and Li J designed and performed the research; Zhang C, Li A and Luo T performed the angiography; Li Y and Li F contributed the analytical tools; Zhang C, Li Y, and Li F analyzed and interpreted the data; Zhang C wrote the manuscript; Li A and Li J revised the manuscript; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81800483.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of Xuanwu Hospital, Capital Medical University (Beijing).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: This study meets the requirements of the STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jia Li, MD, PhD, Chief Doctor, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China. Jiali35@126.com
Received: February 1, 2020
Peer-review started: February 1, 2020
First decision: March 15, 2020
Revised: March 17, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: June 28, 2020
ARTICLE HIGHLIGHTS
Research background

Laparoscopic surgery has made it possible for elderly colorectal cancer (CRC) patients to undergo surgical treatment and has become a standard procedure around the world. Handling of the inferior mesenteric artery (IMA) and vein is important in low anterior resection and abdominoperineal excision for radical resection of left-sided CRC. The IMA characteristics and the hemoperfusion region have become one of the important issues related to the anastomotic complication and the outcome of CRC resection in elderly patients. However, the characteristics, bifurcation, and distribution and the hemoperfusion region of the IMA remain unclear in elderly patients

Research motivation

We demonstrated the characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum in elderly patients.

Research objectives

To retrospectively analyze the clinical and IMA angiographic characteristics of 154 patients over 65 years using digital subtraction angiography.

Research methods

We enrolled 154 patients (> 65 years old) who underwent digital subtraction angiography of the IMA. The clinical characteristics, bifurcation, and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined. Perfusion regions were cross-referenced with clinical and anatomical features.

Research results

Of 154 patients, 25 (16.2%) had IMA lesions. The left colic artery arose independently from the IMA in 44.2% of patients, shared a trunk with the sigmoid artery in 35.1%, shared an opening with the sigmoid and superior rectal arteries in 16.9%, and was absent in 5.1%. The IMA perfusion region stopped at the splenic flexure in 50 (32.5%) patients. Collateral circulation other than the marginal artery, including the ascending left colic artery and the arc of Riolan, appeared in 38 patients. The inferior mesenteric artery perfusion region was independently associated with the IMA atherosclerotic lesion, branching pattern, collateral circulation, and marginal artery integrity.

Research conclusions

The IMA and its branches are prone to arteriosclerosis in the elderly population. IMA perfusion may be interrupted at the splenic flexure, the risk for which is increased with an incomplete marginal artery, the lack of other collateral arteries, and the comorbidity of atherosclerosis.

Research perspectives

The applicability and precision of preoperative angiography for the IMA branching and perfusion patterns could facilitate geriatric laparoscopic surgery, especially for the elderly left-sided colorectal cancer patients who are suspected with poor IMA perfusion.