Effect Of Preservation Of Left Colic Artery In Laparoscopic Rectal Cancer Surgery And The Role Of Cephalo-Medial Approach

Objective: To evaluate the feasibility and safety of performing low ligation of the inferior mesenteric artery and preservation of left colic artery in laparoscopic rectal cancer surgery and investigate the role of cephalo-medial approach in the preservation of left colic artery, summarize the surgical strategy and operation skills. Method: From May 2015 to January 2016, a total of 103 consecutive patients underwent laparoscopic rectal cancer surgery in our center were investigated. They were divided into two groups: High Ligation (n=42) and Low ligation (n=61). 61 patients in LL group were divided into two groups based on the surgical approach: Medial Approach group(n=29)and Cephalo-medial group(n=31).Clinical data of patient characteristics, operative procedure, pathology of primary tumor and lymph nodes, post-operative recovery and short-term clinical outcome were reviewed. Result : All 103 cases were successfully operated without conversion to laparotomy and post operative mortality. Age, gender, BMI, ASA score, tumor size and tumor location were not statistically different between the two groups. Total number of lymph node harvest in HL group was 16.08±6.77 and 15.47±7.23 in LL group.Total IMA node harvest in HL group was 4.18±1.69 with a positive rate of 9.5%(4/42)and 4.31±1.74 in LL group with a positive rate of 4.9%(3/61),both were found no significantly difference between the two groups. In HL group, there were 4 cases(9.5%) had colonic ischemic change during operation leading to extra removal of colon, significantly higher than that in LL group (0%). There were no significant differences in terms of operation time, blood loss, post-operative complication, recovery of bowel movement and hospital stay.In 61 cases of LL group patients,number of No.253 lymph node harvested in CC group(3.31±1.2)was significantly more MA group(1.93±1.2).There were no significant differences in terms of OR time,blood loss,anastomotic rate, recovery of bowel movement and hospital stay. Conclusion: Low ligation with preservation of LCA is able to perform same lymphatic clearance including dissection of the lymph nodes around the root of aorta as High ligation without prolonged operation time,while it provide better blood supply to anastomosis and may reduce the risk of anastomotic leakage.The Cephalo-medial approach is safe and feasible and provides benefit in lymph node dissection than Medial approach...