Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer

Abstract

Background D3 lymph node dissection with left colic artery (LCA) preservation in rectal cancer surgery seems to have little effect on reducing postoperative anastomotic leakage. So we first propose D3 lymph node dissection with LCA and first sigmoid artery (SA) preservation. This novel procedure deserves further study. Methods Rectal cancer patients who underwent laparoscopic D3 lymph node dissection with LCA preservation or with LCA and first SA preservation between January 2017 and January 2020 were retrospectively assessed. The patients were categorized into two groups: the preservation of the LCA group and the preservation of the LCA and first SA group. A 1:1 propensity score-matched analysis was performed to decrease confounding. Results Propensity score matching yielded 56 patients in each group from the eligible patients. The rate of postoperative anastomotic leakage in the preservation of the LCA and first SA group was significantly lower than that in the LCA preservation group (7.1% vs. 0%, P=0.040). No significant differences were observed in operation time, length of hospital stay, estimated blood loss, length of distal margin, lymph node retrieval, apical lymph node retrieval, and complications. A survival analysis showed patients’ 3-year disease-free survival (DFS) rates of group 1 and group 2 were 81.8% and 83.5% (P=0.595), respectively. Conclusion D3 lymph node dissection with LCA and first SA preservation for rectal cancer may help reduce the incidence of anastomotic leakage without compromising oncological outcomes compare with D3 lymph node dissection with LCA preservation alone.

Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer after neoadjuvant therapy – a video vignette

“…What needs to be stated is that although this is a good technique for rectal cancer patients it is not a universal procedure for all patients. As we have mentioned before [12], sometimes preservation of first the SA may lead to anastomotic tension, and even to anastomotic failure. If the tension is identified after anastomosis, the patient would accept additional mobilization or even complete mobilization of the splenic flexure, so sacrificing the preserved LCA and/or SA is our last resort.…”

“…Although preservation of the left colic artery (LCA) has become more and more popular in rectal cancer surgery, it seems to have a limited role in preventing anastomotic leakage compared with nonpreservation of the LCA [6][7][8][9]. In recent years, we have focused on the surgical technique of D3 lymph node dissection with preservation of more branches of the IMA in rectal cancer surgery, and first proposed D3 lymph node dissection with preservation of the LCA and first sigmoid artery (SA) in rectal cancer surgery [10][11][12]. Our previous study found that preservation of the LCA and the first SA may be more important than preservation of the LCA alone [12].…”

“…In recent years, we have focused on the surgical technique of D3 lymph node dissection with preservation of more branches of the IMA in rectal cancer surgery, and first proposed D3 lymph node dissection with preservation of the LCA and first sigmoid artery (SA) in rectal cancer surgery [10][11][12]. Our previous study found that preservation of the LCA and the first SA may be more important than preservation of the LCA alone [12]. This technique would increase blood flow in the proximal bowel and reduce the incidence of related events, especially for a rectal cancer patient who has received neoadjuvant therapy.…”