Study On Preserving Left Colon Artery Combined With No.253 Lymph Node Dissection In Laparoscopic Radical Resection Of Rectal Cancer

Objectives: This study aims to explore the clinical benefits and oncologic safety of preserving the left colon artery(LCA)combined with No.253 lymph node dissection in laparoscopic radical resection of rectal cancer.Methods: A total of 90 patients who underwent laparoscopic radical resection for rectal cancer in the Department of Gastrointestinal surgery of our hospital from January 2016 to January 2018 were selected.The clinical data and follow-up data of the patients were collected.According to the different ligation levels of the inferior mesenteric artery(IMA)during the operation,patients were divided into the low ligation group(LL group,preserving LCA,n=46)and the high ligation group(HL group,without preserving LCA,n=44).The LL group was ligated below the LCA branch of IMA,while the HL group was ligated at the origin of IMA.Outcome indicators of patients including the general data,intraoperative situation,early complications and recovery time,lymph node dissection situation,and follow-up were compared and analyzed.Results: In terms of intraoperative situation,the operation time of LL group was(175.35±38.97)min and that of HL group was(164.36±33.16)min.And the intraoperative blood loss was 50(20-200)ml in the LL group and 50(5-200)ml in the HL group(P>0.05).In LL group,splenic flexure was free in 2 cases,anal drainage tube was placed in 3 cases,and preventive ileostomy was performed in 3 cases,while in HL group,splenic flexure was free in 7 cases,anal drainage tube was placed in 2 cases,and preventive ileostomy was performed in 6 cases,the intraoperative situation were similar in both groups(P>0.05).The total number of lymph node dissection in the two groups respectively were(20.78±8.29)and(21.64±8.82)(P>0.05).The number of No.253 lymph node dissection in the two groups respectively were 3(0-13)and 4(0-13)(P>0.05).The lymph node metastasis rate of LL group was 32.6%(15/46)and that of HL group was 38.6%(17/44)(P>0.05).The No.253 lymph node metastasis rate of LL group was 2.2%(1/46)and that of HL group was 4.5%(2/44)(P>0.05).No patient with anastomotic leakage(AL)was found in LL group,but 5 patients with AL in HL group(P<0.05).The other complications including ileus,anastomotic bleeding,wound infection,abdominal infection,pulmonary infection and uroschesis were not statistically difference(P>0.05).The first exhaust time was(3.70±1.17)days in LL group compared with(4.32±1.33)days in HL group,which was significantly earlier(P<0.05).Postoperative hospital stay was(12.54±3.13)days in LL group and(13.27±3.41)days in HL group(P>0.05).After 3-year follow-up,it was found that there was no significant difference in the rate of recurrence and metastasis between the LL group and the HL group.The 3-year overall survival of the two groups were 84.8% and 88.6%,respectively(P>0.05).The postoperative survival prognosis of the two groups was similar.Conclusion: LL operation with preservation of LCA can reduce the incidence of postoperative AL,and is conducive to the recovery of bowel function.Meanwhile,LL combined with No.253 lymph node dissection can achieve the same degree of lymph node dissection as HL,and the prognosis of tumor is similar.Moreover,LL does not significantly increase the difficulty of surgery and take more time on the technical level.Therefore,LL is safe and feasible,has more advantages and worthy of promotion compare with HL.