Clinical Comparison Of Laparoscopic Radical Resection Of Rectal Cancer With The Left Colic Artery Reserved Or Resected

ObjectiveTo evaluate the clinical effect and application value of preserving left colonic artery(LCA)during operation based on the different treatment methods for the inferior mesenteric artery(IMA)during laparoscopic low anterior resection of rectal cancer.MethodsClinical data of 226 patients that underwent laparoscopic low anterior resection of rectal cancer in the second affiliated Hospital of Fujian Medical University from March 2017 to July 2019,including 117 cases of high-ligation group(LCA-resected group)and 109 cases of low-ligation group(LCA-reserved group),were retrospectively analyzed.Blood loss during surgery,length of surgery,whether splenic flexure was freed,whether preventive ileostomy was collected,time of first anal exhaust after surgery,whether there was voiding dysfunction,whether there was anastomotic fistula,as well as total number of lymph node dissection,number of lymph node dissection at the root of IMA,length and general type and histological classification and TNM staging of tumor of these patients were recorded.The patients were followed up for 6～34 weeks to understand tumor recurrence/metastasis and identify the risk factors for anastomotic leakage.ResultsThe 2 groups of patients showed no significant differences in gender,age,body mass index,rate of hypertension,rate of diabetes,distance of tumor to anal margin,rate of spleen-freeing,rate of preventive ileostomy,length of tumor,general type of tumor,histological classification and TNM staging of tumor,positive rate of lymph nodes at the root of inferior mesenteric artery,or rate of local and distant recurrence(P>0.05 for all).High-ligation group cost 139.53±32.22 min on average,slightly but significantly shorter than low-ligation group(149.91±34.81 min,P<0.05).Blood loss of the two approaches of surgery showed no significant difference(77.26±49.21 ml vs.81.83±49.44 ml,P>0.05).Anastomotic fistula occurred in 12 patients(10.3%)of the high-ligation group and 8 patients(7.3%)of the low-ligation group,but the difference was not statistically significant(P> 0.05).First anal exhaust after surgery occurred 3.24±1.00 days after surgery in the high-ligation group,which was significantly delayed compared to the low-ligation group(2.87±0.87 days after surgery,P<0.05).Postoperative voiding dysfunction occurred in 17 patients(14.5%)of the high-ligation group,and 9patients(8.3%)of the low-ligation group,but the difference was not statistically significant(P>0.05).No significant difference was observed in total number of lymph node dissection in the high-ligation and low-ligation groups(20.66±8.24 vs.20.17±6.18,P>0.05),or number of lymph node dissection at the root of IMA(4.02±2.03 vs.3.90±1.71,P>0.05).Multivariate analysis showed that the advanced age and distance of tumor to anal margin ≤7cm were independent risk factors for postoperative anastomotic leakage(P<0.05).ConclusionsHigh ligation of IMA and low ligation of IMA showed no significant differences in incidence of anastomotic leakage,rate of lymph node dissection,incidence of voiding dysfunction or short-term efficacy to treat the tumor.Low ligation of IMA facilitates recovery of intestinal function after surgery but takes more time of operation.Preventive ostomy during surgery can be considered for patients with advanced age and tumors within 7cm to anal margin.