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Regional mesenteric recurrence of colorectal cancer after anterior resection or left hemicolectomy: inadequate primary resection demonstrated by angiography of the remaining arterial supply

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Abstract

Inferior mesenteric angiography was carried out in 14 patients with locoregional recurrence following sphincter-saving resection of a colorectal primary tumour in the left hemicolon or rectum. The aim was to check the margins of clearance of the lymphatic drainage. All patients had been operated on electively and with curative intent. All patients had a biopsy-proven recurrence and 11 of the 14 patients (79%) showed residual arteries that should have been resected at primary surgery, and at laparotomy for the recurrence incomplete resection of the lymphatic drainage area was confirmed. In 6 patients the recurrence was resected, in 4 of them with no evidence of microscopic residual disease. From these findings it may be argued that the lymph nodes incompletely resected at primary operation may have been the origin of the locoregional recurrence. Angiography may detect this situation, and may be worthwhile when planning a reintervention.

Résumé

Une angiographie mésentérique inférieure fût pratiquée chez 14 patients ayant une récurrence loco-régionale après résection et anastomose d'une tumeur colorectale primaire du colon gauche ou du rectum. Le but était de vérifier les limites de résection du drainage lymphatique. Tous les patients avaient été opérés électivement et dans un but curatif. Tous les patients avaient une biopsie prouvant la récurrence et 11 malades sur 14 (79%) montraient des résidus artériels qui auraient dû être réséqués lors de la chirurgie primaire; de même à la laparotomie pour la récidive, la résection incomplète des aires de drainage lymphatique a été confirmée. Chez 6 malades la récidive a été réséquée, avec pour 4 d'entreeux l'absence d'évidence de maladie résiduelle microscopique. De ces découvertes on peut conclure que les ganglions lymphatiques incomplètement réséqués à l'opération primaire peuvent avour été l'origine de la récurrence loco-régionale. L'angiographie peut détecter une telle situation et peut être utile lorsqu'on décide une réintervention.

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Hohenberger, P., Schlag, P., Kretzschmar, U. et al. Regional mesenteric recurrence of colorectal cancer after anterior resection or left hemicolectomy: inadequate primary resection demonstrated by angiography of the remaining arterial supply. Int J Colorect Dis 6, 17–23 (1991). https://doi.org/10.1007/BF00703955

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