Low Ligation Combined With LND Versus High Ligation Of Inferior Mesenteric Artery In Efficacy Of Rectosigmoid Carcinoma:a Meta-analysis

Objective:To evaluate the effects of low ligation of inferior mesenteric artery(IMA)combined with lymph node dissection(LND)around the origin of IMA versus high ligation on the prognosis for sigmoid colon and rectal cancers.Methods:Systematic literature retrieval was conducted by searching in a number of electronic databases(January 1982 up to November 2016).In this study,a meta-analysis was performed to involve majority of relevant articles and explore the association of prognosis with two surgical procedures.Operating time,blood loss,numbers of apical lymph nodes and incidence of positive lymph nodes around the origin of IMA,anastomotic leakage rate,incidence of urinary dysfunction,5-year survival rate and 5-year relapse-free survival rate of two surgical methods were observed.The meta-analysis was conducted with RevMan 5.2 software and Stata SE12.0.Results:A total of 1422 patients with carcinoma from 14 studies were included in analysis.Compared with high ligation of IMA,low ligation of IMA combined with LND around the origin of IMA was associated with longer operating time while lower postoperative anastomotic leakage rate,differences in blood loss,postoperative incidence of urinary dysfunction,numbers of apical lymph nodes and incidence of positive lymph nodes around the origin of IMA,postoperative 5-year survival rate and 5-year relapse-free survival rate between the two surgical procedures showed no statistical significance,in radical surgery of rectal and sigmoid colon cancers.Conclusion:Low ligation of IMA combined with LND around the origin of IMA enables the preservation of anastomotic blood flow in the mean time of achieving D3 LND,which guarantees curative resection of tumor and operative safety,and provides a novel vascular and lymph node management mode in patients with high risk factors of anastomotic leakage.