| Objective:To explore the feasibility,safety,and effectiveness of preserving the left colon artery(LCA)combined with apical lymph node dissection in laparoscopic radical resection of rectal cancer.Methods:Collect medical records and follow-up information of 130 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer during their hospitalization period at the Gastrointestinal Department of the Affiliated Southwest Hospital of You Jiang Medical University for Nationalities from January 2018 to December 2020.According to the ligation position of the inferior mesenteric artery(IMA)during surgery,it was divided into a low ligation group(LL group,n=64)and a high ligation group(HL group,n=66).LL is the ligation of the LCA branch after the IMA sends out,preserving the LCA,and cleaning the lymph and adipose tissue around the root tip,which is composed of IMA,LCA,Inferior mesenteric vein(IMV),and the lower margin of the pancreas,namely the NO.253 group lymph nodes;HL is ligated at the beginning of IMA,cleaning the adipolymphatic tissue around the root of IMA without retaining LCA.Collect intraoperative conditions,early postoperative complications and recovery,intraoperative lymph node dissection,and postoperative follow-up of two groups of patients.The statistical software IBM SPSS Statistics 23.0 was used for data analysis.The measurement data were first tested for normality.Those conforming to the normal distribution were expressed as mean±standard deviation((?)±s).The inter group comparison was based on the results of the homogeneity test of variance.After the homogeneity of variance,the two sample t-test was used;Data that do not conform to the normal distribution are described by the median and quartile intervals(M(P25,P75)).The Mann Whitney U test is used for inter group comparison,and the rank sum test of two independent samples is used.Counting data is expressed in examples and percentages,using chi-square χ~2.The test level is 0.05,and P<0.05 is a significant difference with statistical significance.The survival status of the two groups was compared using Kaplan-Meier analysis method and Log-rank test.The survival curve was created using Graph Pad Prism,8.0.2 software,and the test level was 0.05.When P<0.05,the difference was significant and statistically significant.Results: 1.During the surgery,the surgical time in the LL group was 194.45 ± 9.66 minutes,while in the HL group it was 182.95 ± 9.93 minutes.There was a significant difference between the two groups(P<0.05).The intraoperative bleeding volume was 80(60,100)ml in the LL group and 80(65,100)ml in the HL group;During surgery,there was 1case of free colonic splenic curvature in the LL group,while there was no free splenic curvature in the HL group;There was no significant difference in intraoperative bleeding and free splenic curvature between the two groups(P>0.05).2.Lymph node dissection: The total number of lymph node dissection in the LL group was 12(9,15.75),HL group was 12(7.75,15),LL group No.253 had 2(0,4),and HL group had 1.5(0,4).The total positive rate of lymph nodes in the LL group was 43.6%(28/64),and the positive rate of No.253 lymph nodes was 10.9%(7/64).In the HL group,the total positive rate of lymph nodes was 47.0%(31/66),and the positive rate of No.253 lymph nodes was 7.6%(5/66).There was no significant difference in lymph node dissection between the two groups(P>0.05).3.Surgical complications and postoperative recovery: In the LL group,there was 1 case of anastomotic leakage(AL)and 7 cases of low anterior resection syndrome(LARS),while in the HL group,there were 7 cases of AL and 14 cases of LARS.There was a significant difference in AL and LARS between the two groups(P<0.05).There was no significant difference in postoperative complications such as anastomotic bleeding,surgical site infection,abdominal infection,and pulmonary infection between the two groups(P>0.05).The first anal exhaust time in the LL group was 3(3,4)days,while in the HL group it was 3(3,4)days;The postoperative hospital stay in the LL group was9(9,11)days,while in the HL group it was 10(9,11)days;The first postoperative ambulation time was 3(3,4)days in the LL group and 3(3,4)days in the HL group,with no significant difference between the two groups(P>0.05).4.Postoperative follow-up: During the 2-year follow-up,there was no local recurrence in the LL group,but there was 1 case of liver metastasis.In the HL group,there were 2 cases of local recurrence and 1 case of liver metastasis,and there was no significant difference in local recurrence and distant metastasis between the two groups(P>0.05).The overall 2-year survival rates of the two groups were89.1% and 90.9%,respectively.There was no significant difference in the 2-year survival prognosis between the two groups(P>0.05).Conclusion: 1.Compared with the non preservation group,LCA preservation combined with apical lymph node dissection for laparoscopic radical resection of rectal cancer increases surgical operation time,does not prolong postoperative recovery time and hospitalization time.2.There was no significant difference in lymph node dissection and prognostic oncology indicators between the LCA preserving group and the apical lymph node dissection group for laparoscopic radical resection of rectal cancer.3.Preserving LCA combined with apical lymph node dissection for laparoscopic radical resection of rectal cancer has more advantages than the non preserving group,significantly reducing the complications of AL and LARS.It is safe,feasible,and effective,and worthy of promotion and application in clinical practice. |
PDF Full Text Request