[Controversy and consideration of high and low ligation of inferior mesenteric artery in radical resection of rectal cancer].

Radical resection is one of the most important treatment for rectal cancer, which requires not only removal of adequate bowel and mesorectum around the tumor, but also thorough lymphadenectomy. Besides, postoperative complications are surgeons' concerns as well. According to different ways to manage inferior mesenteric artery, procedures could be divided into two groups: inferior mesenteric artery (IMA) high ligation and low ligation, which lead to various outcomes of the extent of lymph nodes dissection, survival, preservation of intestinal blood supply, incidence of anastomotic leakage, and postoperative functions including defecation function, urinary function and sexual function. Author believes that for those patients with clinical stage T1, low ligation and D2 lymph nodes dissection could be considered. However, for patients with locally advanced carcinomas (clinical stage T2+or N+), especially suspicious metastasis of lymph nodes around IMA root, high ligation and D3 lymph node dissection is suggested to ensure en bloc resection. As for those patients with high risks for compromised intestinal blood supply, preservation of left colic artery plus D3 lymph nodes dissection might be a feasible way. Intraoperative indocyanine green fluorescent imaging might play a role in quality control of lymphadenectomy.根治性手术是直肠癌患者获得治愈的主要手段。直肠癌根治术不仅需要切除足够的肠管和完整的系膜，还要确保彻底的淋巴结清扫和较低的术后并发症发生率。肠系膜下动脉的结扎分为高位和低位结扎，其选择对淋巴结清扫和预后、吻合口漏和肠管血运，以及术后排便、排尿和性功能保护具有重要意义。对于临床分期较早的T1期患者可以实施低位结扎D2淋巴结清扫；对于肿瘤局部分期较晚，尤其是怀疑肠系膜下动脉根部淋巴结转移者，则建议实施肠系膜下动脉高位结扎D3淋巴结清扫，以确保肠系膜下动脉根部淋巴结获得整块切除；而对于可能存在肠管血运不良风险的局部进展期直肠癌患者，可谨慎实施保留左结肠动脉的直肠癌D3淋巴结清扫，术中吲哚菁绿淋巴示踪可能对淋巴结清扫的质量控制发挥一定作用。.