Oncological Impact of Laparoscopic Lymphadenectomy with Preservation of the Left Colic Artery for Advanced Sigmoid and Rectosigmoid Colon Cancer

Yamamoto, Masashi; Okuda, Jun; Tanaka, Keitaro; Ishii, Masatsugu; Hamamoto, Hiroki; Uchiyama, Kazuhisa

doi:10.1159/000369938

Cited by 30 publications

(29 citation statements)

References 20 publications

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“…In contrast, Fujii S et al [8] found that the level of IMA ligation does not significantly influence the incidence of anastomotic leakage. 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].…”

Section: Discussionsupporting

confidence: 90%

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: 90%

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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“…Yamamoto et al . further found that low tie with LND in patients with advanced sigmoid and rectal cancer resulted in acceptable outcomes .…”

Section: Discussionmentioning

confidence: 93%

“…Similar studies have been conducted in patients with different tumour stages. [15]. However, regardless of the stage, the metastasis status of the IMA-LNs remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of inferior mesenteric artery lymph node metastasis in cancer of the descending colon, sigmoid colon and rectum

et al. 2018

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“…In a comparison of the two groups, preserving the LCA was associated with a larger volume of blood loss. (7,(9)(10)(11)15) were included, involving 961 patients with rectal cancer. A meta-analysis, which applied the fixed-effects model, revealed that there was a significant difference between preservation and non-preservation of the LCA in laparoscopic resection of rectal cancer (RR=-2.28; 95% CI: -3.08, -1.48; P<0.01; Fig.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the clinical efficacy of preserving the left colic artery in laparoscopic resection for rectal cancer: A meta‑analysis

Fan

Zhang

et al. 2018

mol clin onc

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The aim of the present meta-analysis compared left colic artery (LCA) preservation with non-preservation in laparoscopic resection of rectal cancer in terms of feasibility, efficacy and safety. The PubMed, Ovid, Embase, Web of Science, CBM, CNKI, VIP and WanFang Data databases were searched prior to June 2017 for studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer. Two researchers screened the literature independently, extracted the data and evaluated the risk of bias. The study was performed using RevMan 5.3 software for meta-analysis. A total of 10 studies comparing LCA preservation and non-preservation in laparoscopic resection for rectal cancer were selected for this meta-analysis, with a combined study population of 1,471 patients. The results of the meta-analysis demonstrated that, when comparing LCA preservation with non-preservation in laparoscopic resection for rectal cancer, there were significant differences between the two groups in terms of operative time (P<0.01), estimated blood loss (P<0.01), percentage of neostomy (P<0.01), the number of retrieved lymph nodes (P<0.01), time to first postoperative exhaust (P<0.01) and amount of anastomotic leakage (P<0.01). However, there were no significant differences in postoperative hospital stay (P=0.28), incidence of recurrence (P=0.73) and incidence of metastasis (P=0.52). Therefore, compared with LCA non-preservation, patients in whom the LCA was preserved during laparoscopic resection for rectal cancer had a better prognosis. However, there was no difference in recurrence or metastasis between the two groups. Although the operative time and estimated blood loss were increased with LCA preservation, these may be reduced with improving proficiency of the operating surgeons. The conclusions of the present study require verification by larger samples and high-quality randomized controlled trials.

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Oncological Impact of Laparoscopic Lymphadenectomy with Preservation of the Left Colic Artery for Advanced Sigmoid and Rectosigmoid Colon Cancer

Cited by 30 publications

References 20 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

Prognostic value of inferior mesenteric artery lymph node metastasis in cancer of the descending colon, sigmoid colon and rectum

Evaluation of the clinical efficacy of preserving the left colic artery in laparoscopic resection for rectal cancer: A meta‑analysis

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