{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:20:43Z","timestamp":1762917643247},"reference-count":4,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,6,8]],"date-time":"2016-06-08T00:00:00Z","timestamp":1465344000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>It is controversial whether a high or low ligation of the inferior mesenteric artery (<jats:styled-content style=\"fixed-case\">IMA<\/jats:styled-content>) is superior. The former allows an extended lymph node clearance whereas the latter preserves the distal vascular supply via the left colic artery (<jats:styled-content style=\"fixed-case\">LCA<\/jats:styled-content>). Apical lymph node dissection of the <jats:styled-content style=\"fixed-case\">IMA<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>) harvests nodal tissue along the <jats:styled-content style=\"fixed-case\">IMA<\/jats:styled-content> proximal to the <jats:styled-content style=\"fixed-case\">LCA<\/jats:styled-content> whilst performing a low ligation. This anatomically replicates the oncological benefit of high ligation and the vascular preservation of low ligation. Our study evaluates the nodal yield of <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content> and the short\u2010term outcome of this technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We retrospectively studied 19 patients with sigmoid or rectal cancer who underwent curative surgical resection with <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>. All <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>s were performed with a standard technique previously described (Kobayashi <jats:italic>et\u00a0al<\/jats:italic>., <jats:italic>Surg Endosc<\/jats:italic> 2005, 20:563\u20139; Sekimoto <jats:italic>et\u00a0al. Surg Endosc<\/jats:italic> 2010, 25:861\u20136) . The lymph node yield from the dissection (the <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content> specimen) was compared with the total lymph node yield. Data on the <jats:styled-content style=\"fixed-case\">LCA<\/jats:styled-content> anatomy, time required to perform <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>, complications and postoperative recovery were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content> was successful in 18 patients. Median postoperative hospitalization was 5 (2\u201326)\u00a0days without <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>\u2010related morbidity or mortality. The median lymph node yield was 20 (9\u201341) and a median of 14.3 (0\u201380)% were harvested with <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>. Two patients not having neoadjuvant chemoradiotherapy had fewer than 12 lymph nodes, excluding nodes harvested from <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content>. The average time required for <jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content> was 18\u00a0min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">ALMA<\/jats:styled-content> is a safe and feasible technique, allowing extended lymphadenectomy without sacrificing the <jats:styled-content style=\"fixed-case\">LCA<\/jats:styled-content>. In this small group of patients none were upstaged due to cancerous involvement of the proximal nodes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13299","type":"journal-article","created":{"date-parts":[[2016,2,16]],"date-time":"2016-02-16T09:06:58Z","timestamp":1455613618000},"update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Apical lymph node dissection of the inferior mesenteric artery"],"prefix":"10.1111","volume":"18","author":[{"given":"N.","family":"Goh","sequence":"first","affiliation":[{"name":"National University of Singapore Yong Loo Lin School of Medicine Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. S.","family":"Fong","sequence":"additional","affiliation":[{"name":"General Surgery Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Y.","family":"How","sequence":"additional","affiliation":[{"name":"General Surgery Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Y.","family":"Wong","sequence":"additional","affiliation":[{"name":"General Surgery Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. H.","family":"Loong","sequence":"additional","affiliation":[{"name":"General Surgery Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. T.","family":"Tay","sequence":"additional","affiliation":[{"name":"General Surgery Tan Tock Seng Hospital Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,6,8]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-012-0359-6"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2012.04.004"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5327"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-009-0547-6"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcodi.13299","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.13299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:07:08Z","timestamp":1694664428000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.13299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6]]},"references-count":4,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["10.1111\/codi.13299"],"URL":"https:\/\/doi.org\/10.1111\/codi.13299","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6]]},"assertion":[{"value":"2015-07-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-12-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}