Clinical Observation Of The Laparoscopic Radical Resection Of Rectal Carcinoma With Preservation Of The Left Colonic Artery

Objective: To explore the feasibility and value in laparoscopic anterior resection of rectal carcinoma with preservation of left colic artery.Methods: The clinical data of 104 cases of laparoscopic radical anterior resection(clinical stage ??? and ?)in our hospital from January 2015 to June 2017 were retrospectively analyzed,including 60 cases with preservation of LCA and 44 cases without preservation of LCA.The inferior mesenteric artery(IMA),left colonic artery(ICA),sigmoid artery(SA)or superior rectal artery(SRA),and lymph nodes were dissected through the vasa vasorum approach.The left colonic artery was retained in test group by transecting the inferior mesenteric artery distance of 0.5 to 1.0 cm to the forking.While inferior mesenteric artery was cutting distance of 1.0 to 1.5 cm to the root in the control group.The preventive stoma,intraoperative hemorrhage volume,operative time,postoperative exhaust time,anastomotic leakage,postoperative hospital day,number and histopathological features of the dissected lymph nodes surrounding the inferior mesenteric artery,1ymph node metastasis,defecation function,the rates of local recurrence and metastasis were analyzed between the two groups.Results: The operation was successfully completed by laparoscopic in all the 104 cases,without conversion to open surgery and intraoperative complications.No significant difference was found in intraoperative hemorrhage volume,operative time,postoperative exhaust time,postoperative hospital day,number of the dissected lymph nodes around the root of IMA(all P>0.05).No case in the test group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 2 cases of the control group needed to free splenic flexure of colon because of high tonus in the stoma(P=0.177),and these 2 cases underwent terminal ileum stoma following anastomosis;and another one needed to underwent terminal ileum stoma(P=0.073)because of blood supply disorder in the proximal intestine,there are 3 all.There is 1 case anastomotic leakage occurred in the test group,while 6 cases of anastomotic leakage occurred in the control group whin 5 days after operation(P=0.040),(not terminal ileum stoma),the difference was statistically significant.Frequency of defecation in control group was significantly higher than that in test group[5(2~8)times/day VS 3(1~6)times/day](P<0.05)during postoperative 3-month follow—up,whereas other indexes of defecation function were not significantly different(P>0.05).Median follow-up time was 20 months(3 to 33 months),no one had local recurrence,3 cases had liver metastasis in the test group while 1 case had local recurrence(P=0.241)and 1 case had liver metastasis(P=0.475)in the control group,the difference was statistically significant(P>0.05).Conclusion: Laparoscopic radical resection of the rectal carcinoma with preservation of the left colonic artery can be completed in patients with rectal carcinoma planning to receive Dixon operation(clinical stage??? and ?).This treament is feasible,safe and effective.It can provide better blood supply for stoma,and can achieve same radical clearance of lymph nodes as high ligation without prolonged operation time.At the same time,it can reduce the influence on defecation function,which is worth clinical promotion.