Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection for Rectal Cancer Reduces Genitourinary Dysfunction

Mari, Giulio; Crippa, Jacopo; Cocozza, Eugenio; Berselli, Mattia; Livraghi, Lorenzo; Carzaniga, Pierluigi; Valenti, Francesco; Roscio, Francesco; Ferrari, C; Mazzola, Michele; Magistro, Carmelo; Origi, Matteo; Forgione, Antonello; Zuliani, Walter; Scandroglio, Ildo; Pugliese, Raffaele; Costanzi, Andrea; Maggioni, Dario

doi:10.1097/sla.0000000000002947

Cited by 110 publications

(125 citation statements)

References 37 publications

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“…The total number of harvested LNs and the number of positive LNs show no differences between the two groups, which was similar to the results of previous study [33,34]. Furthermore, previous studies have confirmed that low ligation of IMA in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction [35]. However, this outcome was not observed in this study, possibly because dissection of the IMA root LNs inevitably injured the superior hypogastric plexus.…”

Section: Discussionsupporting

confidence: 91%

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Zheng

Tian

et al. 2020

Preprint

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Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

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Section: Discussionsupporting

confidence: 91%

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Zheng

Tian

et al. 2020

Preprint

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“…The intraoperative parameters and postoperative complication rates were important indexes for demonstrating the e cacy of quality control in a surgical procedure. A previous RCT study showed that the LCA preservation or not does not increase the duration of laparoscopic low anterior resection of rectal cancer [10]. Our study revealed the mean operating time of the LCA preservation group was 75 minutes signi cantly longer than that of the LCA non-preservation group.…”

Section: Discussionmentioning

confidence: 42%

“…Nevertheless, preserving the LCA or not during laparoscopic low anterior resection of rectal cancer, is still debated. A randomized multicenter controlled trial showed that low ligation of the IMA in laparoscopic rectal cancer surgery resulted in better genitourinary function preservation without affecting initial oncological outcomes, while high ligation of the IMA did not increase the anastomotic stula rate [10]. However, the effect of high or low ligation of IMA on long-term oncologic outcomes was not reported in this study.…”

Section: Introductionmentioning

confidence: 58%

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Luo¹,

Li²,

Wu³

et al. 2020

Preprint

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Aim To analyze the effect of preserving the left colic artery (LCA) on long-term oncologic outcomes during laparoscopic low anterior resection of rectal cancer. Methods Clinicopathological and follow-up patients undergoing laparoscopic low anterior resection of rectal cancer in general surgery department of Guangdong Provincial People's Hospital from January 2014 to December 2015 were retrospectively collected. According to the difference surgical methods of inferior mesenteric artery (IMA), 159 cases were divided into the LCA preservation group and 225 cases in the LCA non-preservation group. The 5-year rates of overall survival (OS) and disease-free survival (DFS) were compared between two group. Results 384 patients were included in final analysis. Anastomotic leakage occurred in 7 patients (4.4%) in the LCA preservation group and in 16 patients (7.1%) in the LCA non-preservation group. The follow-up rate was 91.2% (145/159) during 5–60 months in LCA preservation group, and 89.8% (202/225) during 5–60 months in the LCA non-preservation group. The number of patients who developed death, local recurrence and metastasis were 59 (37.1%), 13 (8.2%) and 60 (37.7%) in the LCA preservation group, and 86 (38.2%), 20 (8.9%) and 92 (40.9%) in the LCA non-preservation group, without significant differences (all P ༞ 0.05). The 5-year OS and DFS rates were 69.0% and 59.3% in the LCA preservation group, and 68.8% and 55.9% in the LCA non-preservation group, without significant differences (all P ༞ 0.05). After stratification by TNM Stage, the difference on 5-year OS rates and DFS rates of I stage, II stage and III stage in two groups were no significant as well (all P ༞ 0.05). Conclusions The long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the LCA are comparable with ligation at origin of IMA.

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“…Details of the included studies were collected (Table 1). Seven RCTs [18][19][20][21][22][23][24], 19…”

Section: Study Characteristicsmentioning

confidence: 99%

“…RC/PC studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], and two CC studies [44,45] published between 2011 and 2019 were analyzed, investigating 10,545 patients (including 4920 patients who underwent LCA non-preservation surgery and 5625 patients who underwent LCA preservation surgery) (CRC group). Additionally, 18 studies on RC alone (including 7 RCTs [18][19][20][21][22][23][24] and 11 RC/PC studies [25, 26, 28, 30-32, 35, 38, 39, 42, 43]) with 7142 patients (including 3468 patients who underwent LCA non-preservation surgery and 3674 who underwent LCA preservation surgery) were extracted for the subgroup analysis (RC group). Studies were assessed using the Cochrane and NOS scoring systems.…”

Section: Study Characteristicsmentioning

confidence: 99%

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

Wang

et al. 2020

Preprint

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Background: Left colic artery (LCA) preservation or non-preservation in radical resection for colorectal cancer is still under debate. This study aimed to compare the perioperative and oncological outcomes between the two procedures.Methods: Systematic search was performed in PubMed, Medline, Embase, Web of Science, and China National Knowledge Infrastructure databases for relevant randomized and non-randomized clinical trials published between 2011 and 2019. The primary endpoints were 5-year overall survival (OS), 5-year disease-free survival (DFS), total lymph nodes harvested, and anastomotic leakage. Secondary endpoints included the number of metastatic lymph nodes, intraoperative blood loss, urinary dysfunction, bowel obstruction, and operation time. Results: Twenty-eight studies with 10545 patients (LCA non-preservation surgery, 4920; LCA preservation surgery, 5625) were included. Data of 7142 rectal cancer patients (LCA non-preservation surgery, 3468; LCA preservation surgery, 3674) were extracted for subgroup analysis. There was significantly lower incidence of anastomotic leakage (odds ratio=1.21; 95% confidence interval |1.04, 1.41|; P=0.015) in colorectal cancer patients with LCA preservation. When rectal cancer was independently analyzed, no significant difference was found in anastomotic leakage between the groups. There were significantly more metastatic lymph nodes and significantly shorter operation time in colorectal cancer and rectal cancer patients with LCA non-preservation. No significant difference was found regarding 5-year OS, 5-year DFS, total lymph nodes harvested, intraoperative blood loss, urinary dysfunction, and bowel obstruction for colorectal and rectal cancer.Conclusions: LCA non-preservation was not proved to increase anastomotic leakage in rectal cancer surgery and was associated with more harvested metastatic lymph nodes and shorter operation time. Trial registration: A review protocol was registered on PROSPERO (registration number: CRD42020183906) and http://www.researchregistry.com (registration number: reviewregistry841).

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Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection for Rectal Cancer Reduces Genitourinary Dysfunction

Abstract: LL of the IMA in LAR + TME results in better GU function preservation without affecting initial oncological outcomes. HL does not seem to increase the anastomotic leak rate.

Cited by 110 publications

References 37 publications

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

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