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Langenbeck's Archives of Surgery Jul 2023The aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA) ligation on post-operative and oncological outcomes in rectal cancer surgery.
METHODS
We conducted a systematic review of the literature up to 06 September 2022. Included were RCTs that compared patients who underwent high (HL) vs. anterior (LL) IMA ligation for resection of rectal cancer. The literature search was performed on Medline/PubMed, Scopus, and the Web of Science without any language restrictions. The primary endpoint was overall anastomotic leakage (AL). Secondary endpoints were oncological outcomes, intraoperative complications, urogenital functional outcomes, and length of hospital stay.
RESULTS
Eleven RCTs (1331 patients) were included. The overall rate of AL was lower in the LL group, but the difference was not statistically significant (RR 1.43, 95% CI 0.95 to 2.96). The overall number of harvested lymph nodes was higher in the LL group, but the difference was not statistically significant (MD 0.93, 95% CI - 2.21 to 0.34). The number of lymph nodes harvested was assessed in 256 patients, and all had a laparoscopic procedure. The number of lymph nodes was higher when LL was associated with lymphadenectomy of the vascular root than when IMA was ligated at its origin, but there the difference was not statistically significant (MD - 0.37, 95% CI - 1.00 to 0.26). Overall survival at 5 years was slightly better in the LL group, but the difference was not statistically significant (RR 0.98, 95% CI 0.93 to 1.05). Disease-free survival at 5 years was higher in the LL group, but the difference was not statistically significant (RR 0.97, 95% CI 0.89 to 1.04).
CONCLUSIONS
There is no evidence to support HL or LL according to results in terms of AL or oncologic outcome. Moreover, there is not enough evidence to determine the impact of the level of IMA ligation on functional outcomes. The level of IMA ligation should be chosen case by case based on expected functional and oncological outcomes.
Topics: Humans; Mesenteric Artery, Inferior; Rectal Neoplasms; Rectum; Lymph Node Excision; Lymph Nodes; Anastomotic Leak; Ligation; Laparoscopy
PubMed: 37493853
DOI: 10.1007/s00423-023-03022-z -
Pediatric Radiology Sep 2023The role of postnatal Doppler measurements of the superior mesenteric artery (SMA) in detecting neonates at risk of necrotizing enterocolitis (NEC) remains uncertain;... (Meta-Analysis)
Meta-Analysis Review
The role of postnatal Doppler measurements of the superior mesenteric artery (SMA) in detecting neonates at risk of necrotizing enterocolitis (NEC) remains uncertain; therefore, we systematically reviewed and meta-analyzed the existing evidence regarding the usefulness of SMA Doppler measurements in detecting neonates at risk for NEC. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and we included studies which reported the following Doppler ultrasonography indices: peak systolic velocity, end-diastolic velocity, time average mean velocity, differential velocity, pulsatility index (PI) and resistive index. Eight studies were eligible for inclusion in the meta-analysis. Evidence suggested that, during the first postnatal day, neonates who developed NEC had a significantly higher peak systolic velocity (mean difference of 2.65 cm/s (95% confidence interval [CI] 1.23, 4.06, overall effect Z=3.66, P<0.001)), higher PI (mean difference of 1.52 (95% CI 0.00, 3.04, Z=1.96, P=0.05)) and higher resistive index (mean difference of 1.09 (95% CI 0.59, 1.60, Z=4.24, P<0.001)), compared to neonates who did not develop NEC. However, our findings do not support a strong association between the Doppler ultrasound indices and development of NEC at the time of disease onset. This meta-analysis suggests that first postnatal day SMA Doppler parameters, namely peak systolic velocity, PI and resistive index, are higher in neonates who develop NEC. On the other hand, the aforementioned indices are of uncertain significance once the diagnosis of NEC has been established.
Topics: Female; Infant, Newborn; Humans; Enterocolitis, Necrotizing; Mesenteric Artery, Superior; Ultrasonography; Ultrasonography, Doppler; Infant, Newborn, Diseases; Fetal Diseases; Blood Flow Velocity
PubMed: 37310444
DOI: 10.1007/s00247-023-05695-6 -
Journal of Vascular Surgery Oct 2018Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients.
METHODS
We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates.
RESULTS
In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients.
CONCLUSIONS
Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.
Topics: Adult; Aged; Aged, 80 and over; Aortic Dissection; Anticoagulants; Asymptomatic Diseases; Celiac Artery; Clinical Decision-Making; Conservative Treatment; Endovascular Procedures; Female; Fibrinolytic Agents; Humans; Male; Mesenteric Artery, Superior; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Risk Factors; Time Factors; Treatment Outcome; Vascular Remodeling; Vascular Surgical Procedures
PubMed: 30126785
DOI: 10.1016/j.jvs.2018.05.014 -
Korean Circulation Journal May 2019The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive... (Review)
Review
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
PubMed: 31074212
DOI: 10.4070/kcj.2018.0429 -
Asian Journal of Surgery Apr 2022
Meta-Analysis
Topics: Aortic Dissection; China; Endovascular Procedures; Humans; Mesenteric Artery, Superior; Treatment Outcome
PubMed: 35183417
DOI: 10.1016/j.asjsur.2022.01.062 -
Journal of Vascular Surgery Jun 2016Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported... (Review)
Review
OBJECTIVE
Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management.
METHODS
A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted.
RESULTS
The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice.
CONCLUSIONS
The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Computed Tomography Angiography; Female; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome; Vascular Surgical Procedures; Young Adult
PubMed: 26951998
DOI: 10.1016/j.jvs.2016.01.031 -
Medicina (Kaunas, Lithuania) Aug 2022: This study aimed to compare the effects of high ligation (HL) versus low ligation (LL) in colorectal cancer surgery. : We performed a comprehensive search using... (Meta-Analysis)
Meta-Analysis Review
: This study aimed to compare the effects of high ligation (HL) versus low ligation (LL) in colorectal cancer surgery. : We performed a comprehensive search using multiple databases (trial registries and ClinicalTrials.gov), other sources of grey literature, and conference proceedings, with no restrictions on the language or publication status, up until 10 March 2021. We included all parallel-group randomized controlled trials (RCTs) and considered cluster RCTs for inclusion. The risk of bias domains were "low risk," "high risk," or "unclear risk." We performed statistical analyses using a random-effects model and interpreted the results according to the . We used the GRADE guidelines to rate the certainty of evidence (CoE) of the randomized controlled trials. : We found 12 studies (24 articles) from our search. We were very uncertain about the effects of HL on overall mortality, disease recurrence, cancer-specific mortality, postoperative mortality, and anastomotic leakage (very low CoE). There may be little to no difference between HL and LL in postoperative complications (low CoE). For short-term follow-up (within 6 months), HL may reduce defecatory function (constipation; low CoE). While HL and LL may have similar effects on sexual function in men, HL may reduce female sexual function compared with LL (low CoE). For long-term follow-up (beyond 6 months), HL may reduce defecatory function (constipation; low CoE). There were discrepancies in the effects regarding urinary dysfunction according to which questionnaire was used in the studies. HL may reduce male and female sexual function (low CoE). : We are very uncertain about the effects of HL on survival outcomes, and there is no difference in the incidence of postoperative complications between HL and LL. More rigorous RCTs are necessary to evaluate the effect of HL and LL on functional outcomes.
Topics: Colorectal Neoplasms; Constipation; Female; Humans; Ligation; Male; Mesenteric Artery, Inferior; Postoperative Complications
PubMed: 36143820
DOI: 10.3390/medicina58091143 -
Scandinavian Journal of Surgery : SJS :... Jun 2021There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac...
BACKGROUND AND AIMS
There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case-control studies are now available, while randomized controlled trials are awaited.
MATERIAL AND METHODS
The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis.
RESULTS AND CONCLUSIONS
Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
Topics: Dissection; Humans; Male; Mesenteric Arteries; Retrospective Studies; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 33724090
DOI: 10.1177/14574969211000546 -
Langenbeck's Archives of Surgery Jan 2023Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains...
INTRODUCTION
Compression syndromes of the celiac artery (CAS) or superior mesenteric artery (SMAS) are rare conditions that are difficult to diagnose; optimal treatment remains complex, and symptoms often persist after surgery. We aim to review the literature on surgical treatment and postoperative outcome in CAS and SMAS syndrome.
METHODS
A systematic literature review of medical literature databases on the surgical treatment of CAS and SMAS syndrome was performed from 2000 to 2022. Articles were included according to PROSPERO guidelines. The primary endpoint was the failure-to-treat rate, defined as persistence of symptoms at first follow-up.
RESULTS
Twenty-three studies on CAS (n = 548) and 11 on SMAS (n = 168) undergoing surgery were included. Failure-to-treat rate was 28% for CAS and 21% for SMAS. Intraoperative blood loss was 95 ml (0-217) and 31 ml (21-50), respectively, and conversion rate was 4% in CAS patients and 0% for SMAS. Major postoperative morbidity was 2% for each group, and mortality was described in 0% of CAS and 0.4% of SMAS patients. Median length of stay was 3 days (1-12) for CAS and 5 days (1-10) for SMAS patients. Consequently, 47% of CAS and 5% of SMAS patients underwent subsequent interventions for persisting symptoms.
CONCLUSION
Failure of surgical treatment was observed in up to every forth patient with a high rate of subsequent interventions. A thorough preoperative work-up with a careful patient selection is of paramount importance. Nevertheless, the surgical procedure was associated with a beneficial risk profile and can be performed minimally invasive.
Topics: Humans; Anastomosis, Surgical; Celiac Artery; Mesenteric Artery, Superior; Superior Mesenteric Artery Syndrome
PubMed: 36690823
DOI: 10.1007/s00423-023-02803-w -
Saudi Medical Journal Jul 2016To compares the effectiveness and impact of high inferior mesenteric artery (IMA) versus low IMA ligation on 5-year survival, lymph node yield rates, and peri-operative... (Review)
Review
OBJECTIVES
To compares the effectiveness and impact of high inferior mesenteric artery (IMA) versus low IMA ligation on 5-year survival, lymph node yield rates, and peri-operative morbidity and mortality.
METHODS
The databases of Educational Resources Information Centre (ERIC), the Web of Science, EBSCO and MEDLINE were searched using MeSH terms 'colorectal cancer', 'inferior mesenteric artery', 'high ligation', 'low ligation', 'mesenteric lymph nodes', 'prognosis', and 'survival'. Only clinical studies were selected and review articles and meta-analysis were excluded. In cases of duplicate cohorts, only the latest article was included. Irrelevant articles and the articles on both right and left sided CRC were excluded. The finally selected studies were analysed for the defined end-point outcomes.
RESULTS
The published data has shown that high IMA ligation improves the yield of harvested lymph node that allows accurate tumor staging and a more reliable estimation of prognosis. High ligation was not found to be positively correlated with increased anastomotic leakage or impaired genito-urinary function. However, high ligation demands advanced surgical expertise and longer operating time. There was no significant difference in 5-year survival rates for both techniques. Some studies have reported fatal complications of high ligation such as proximal bowel necrosis.
CONCLUSION
Although there is no consensus, this research signals the routine use of high ligation for left-sided CRC. However, the published fatal complications following high ligation and no significant difference in 5-year survival rates demand more studies to establishing a unified protocol.
Topics: Colorectal Neoplasms; Humans; Mesenteric Artery, Inferior
PubMed: 27381531
DOI: 10.15537/smj.2016.7.14831