eP155 - Effect of IMA Ligation Technique on Bleeding Complications in Rectal Cancer Patients Undergoing Total Mesorectal Excision

ePoster Presenter(s)

• 

  Ama J. Winland, MD

  General Surgery Resident, Research Fellow
  Walter Reed National Military Medical Center, Johns Hopkins Hospital
  Walter Reed National Military Medical Center
  Chevy Chase, MD, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• RS

  Reena Suresh, MBChB

  Research fellow
  Johns Hopkins School of Medicine
  Johns Hopkins School of Medicine
  Baltimore, MD, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• JM

  Jay R. Maturi, BS

  Medical Student
  Johns Hopkins School of Medicine
  Baltimore, Maryland, United States

  Disclosure information not submitted.
• MS

  Miloslawa Stem, MS

  Sr. Biostatistician
  Johns Hopkins Medicine
  Baltimore, Maryland, United States

  Disclosure information not submitted.
• PN

  Peter Najjar

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Susan Gearhart, MD

  Associate Professor of Surgery
  Johns Hopkins University
  Baltimore, MD, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• HC

  Haniee Chung, MD, FACS

  Assistant Professor
  Johns Hopkins School of Medicine
  BALTIMORE, Maryland, United States

  Disclosure information not submitted.
• 

  Alodia Gabre-Kidan, MD, MPH

  Assistant Professor of Surgery
  Johns Hopkins School of Medicine
  Johns Hopkins School of Medicine
  Towson, MD, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• JE

  Jonathan Efron, MD

  Professor of Surgery
  Johns Hopkins Hospital
  Baltimore, Maryland, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Vincent Obias, Chief Division of Colon and Rectal Surgery NCR (he/him/his)

  Professor of Surgery (PAR)
  Johns Hopkins Medicine
  Johns Hopkins Medicine
  bethesda, Maryland, United States

  Disclosure information not submitted.

Purpose/Background: Inferior mesenteric artery (IMA) ligation for left-sided colon and rectal resections is performed by stapling, using an energy device, or suture ligation with the method being the surgeon’s preference.  To our knowledge, there have been no studies that demonstrate whether one technique is superior to others. With minimally invasive techniques on the rise, we sought to address whether utilizing energy devices to transect major vessels like the IMA is a safe practice. The aim of this study was to assess bleeding complications related to IMA ligation technique.Methods/Interventions: This was a retrospective study using an institutional database for adult rectal cancer patients undergoing total mesorectal excision (2006-2021). The association between IMA ligation technique (stapled, energy, or suture ligation) and the primary outcomes of intra- and post-operative bleeding complications necessitating transfusion was assessed. Secondary outcomes included 30-day overall morbidity, anastomotic leak, readmission, reoperation, operative time, and length of stay (LOS). Pairwise comparison of the energy and suture ligation groups was also performed for all primary and secondary outcomes. These variables were analyzed using ANOVA, Pearson's Chi-squared analysis or Fisher's exact test when appropriate.Results/Outcomes: Among the 769 rectal cancer included patients, 69 (8.97%) underwent stapled ligation, 281 (36.54%) underwent energy ligation, and 419 (54.59%) underwent suture ligation. Patients in the suture ligation group tended to have obesity (18.84% stapled vs 18.15% energy vs 22.91% suture ligation; p < 0.001), smoke (40.43% vs 40.21% vs 43.20%; p = 0.041) and undergo an open operative approach (17.39% vs 19.22% vs 92.84%, p < 0.001) compared to the stapled and energy groups. There were no differences in intra- (5.80%, 3.20%, 7.16%; p = 0.082) or post-operative bleeding necessitating transfusion (7.25%, 7.47%, 5.73%; p = 0.634) between the three IMA ligation techniques (Table). However, the suture ligation group had higher rates of intra-operative bleeding than the energy group (7.16% vs 3.20%; p= 0.025). In terms of secondary outcomes, there were more anastomotic leaks in the stapled group (5.80%, 1.07%, 1.43%; p = 0.040), and more wound complications in the suture ligation group (2.90%, 3.56%, 7.88%; p = 0.032). Additionally, the stapled group had longer operative times (median of 400 minutes; Interquartile Range [IQR] 306,469), followed by the energy group (330 minutes; IQR 244,453) and suture ligation group (272 minutes; IQR 213,370), p < 0.001. There were no differences in the rates of overall morbidity, readmission, reoperation, or LOS between the three groups.Conclusion/

Discussion: Energy and stapling of the IMA is as safe as traditional IMA suture ligation. In fact, there may be a potential benefit of energy over suture ligation in decreasing intra-operative bleeding. Additional prospective, case-matched studies are necessary to determine whether there is a significant difference in IMA ligation technique between these three techniques across different operative approaches.30-Day Post-Operative Outcomes for Rectal Cancer Patients Undergoing TME Stratified by IMA Ligation Technique