Lymphadenectomy Around Inferior Mesenteric Artery in Low-Tie vs High-Tie Laparoscopic Anterior Resection: Short- and Long-Term Outcome of a Cohort of 614 Rectal Cancers

Abstract

Background: Preservation of the left colic artery in low-tie (LT) of inferior mesenteric artery remains controversial compared to high-tie (HT) in the colon and rectal cancers, for lymph node dissection, anastomotic leakage, and oncological outcome. This cohort study aims to analyze short-and long-term outcomes of laparoscopic anterior resections in LT vs HT for rectal cancers. Methods: We analyzed a cohort of laparoscopic AR for RC from 2013 to 2016 at Renji Hospital, Shanghai, China. Short-and long-term outcome in LT vs HT group were compared for clinico-demographic characteristics, operative-time, lymph node dissection, short-term 30day outcome, and long-term 3-and 5-year overall survival as well as disease-free survival. The x 2 , t-test, and logistic regressions analysis were used and p<0.05 was considered significant. Results: The cohort consisted of 614 laparoscopic AR with LT (236) and HT (378). The clinicodemographic characteristics were comparable among the groups. The surgery took longer in LT. The yield of LND was similar. Leakage occurred in 12.21% (n=75). Leakage was fewer in LT than HT, 8.89% vs 14.28%, p=0.047. The postoperative severe complications were higher in HT. The 30-day mortality was nil. The long-term 3-and 5-year overall survival and disease-free survival were similar in LT and HT. Conclusion:The LT with preservation of left colic artery had similar lymph node yield, but lower leakage and complications than HT in laparoscopic anterior resections for rectal cancers. The long-term 3-and 5-year overall and disease-free survival were similar in the two groups.

Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis

“…This study shows that LCA preservation plus apical LN dissection surgery has a lower AL rate after anterior resection for rectal cancer (3.3% vs. 13.3%, P = 0.048), similar to findings of previous studies [ 21 , 22 ]. No significant differences were observed in blood loss, operation time, intraoperative complications, splenic flexure mobilization, time to first flatus, total number of harvested LNs, number of positive LNs, or postoperative hospital stay.…”

A clinical study of inferior mesenteric artery typing in laparoscopic radical resections with left colonic artery preservation of rectal cancer

“…In terms of lymph node dissection and tumor outcome, Maeda [ 16 ] reported that low ligation of the IMA and standardized dissection of the D3 lymph node had the same effect as high-ligation lymph node dissection. Luo [ 17 ] found that in laparoscopic radical resection of rectal cancer, there was no significant difference in the number of lymph nodes obtained by LCA-preserving low ligation and high ligation, and the 3-year, 5-year, overall, and disease-free survival rates of patients with the two surgical methods were similar. In terms of complications to patients, You [ 18 ] found that compared with low ligation, high ligation of the IMA reduced anastomotic intestinal blood supply, increased the incidence of postoperative anastomotic stenosis and anastomotic fistula, and damaged the submesenteric nerve plexus, thereby increasing the incidence of postoperative urinary and reproductive system dysfunction.…”

High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections: A retrospective study

“…Seike et al (15) reported that, after clamping the IMA, the anastomotic blood flow of the proximal colon was significantly reduced, which was more evident in elderly men, along with a higher risk of anastomotic leakage. Other studies also demonstrated that low ligation could decrease the anastomotic leakage risk (32)(33)(34). Therefore, larger samples are required to further explore the relationship between anastomotic leakage and IMA ligation level in the future.…”