Feasibility Of Preserving Left Colic Artery In Laparoscopic Radical Resection Of Rectal Cancer

Objective:The postoperative data of rectal cancer patients treated with laparoscopic radical resection of rectal cancer were collected and analyzed.To investigate whether it is safe and feasible of preserving left colonic artery instead of traditional radical operation in patients with rectal cancer.To provide a clinical basis for radical resection of preserving left colon artery for patients with rectal cancer.Methods:1.Participants: the inclusion criteria:(1)According to the NCCN guideline 2017 first edition of the rectal cancer,the patients were diagnosed as rectal cancer with stage I,II and III;(2)Patients undergoing laparoscopic radical resection of rectal cancer(Dixon)from July 2014 to January 2017.Exclusion criteria:(1)Patients undergoing preoperative neoadjuvant chemotherapy;(2)Patients who have found rectal cancer during the emergency surgery for intestinal obstruction or intestinal perforation.;(3)Patients with extensive or distant metastasis or metastasis found in the abdominal cavity before and during the operation;(4)Patients with laparotomy need to be converted to laparotomy because of the difficulty of intraoperative laparoscopy;(5)Patients with non adenocarcinoma confirmed by postoperative pathology.;(6)the critically ill patients.A total of 102 cases were excluded from the exclusion criteria,of which 36 were in the retention group and 66 in the unreserved group..2.Grouping method: they were divided into two groups according to the operation of left colon artery in each patient.One group that retained the left colonic artery is defined as the experimental group.By the method of intrathecal vascular anatomy,it is stripped skeletally from the beginning of the inferior mesenteric artery to the bifurcation following 1cm.The scavenging lymph nodes and adipose tissue are the lymph nodes in the root of the inferior mesenteric artery.The superior rectal and sigmoid arteries were clipped and the left colon artery was retained.The other group was the control group,that the left colonic artery was not retained.In the root of the inferior mesenteric artery,the vessels were ligated and cut off,and the lymph nodes and adipose tissue around the inferior mesenteric artery were removed.The subsequent steps were performed according to the laparoscopic total mesorectal excision procedure for rectal cancer.3.Observation index: Intraoperative blood loss,operative time,postoperative exhaust time,postoperative drainage time,anastomotic leakage and postoperative pathology.Postoperative pathological conditions included histological type,number of lymph nodes dissection of inferior mesenteric artery,lymph node metastasis of inferior mesenteric artery and TNM staging.Finally,one year follow-up after the operation,the recurrence and metastasis were compared.The amount of blood loss in the operation and the time of operation were based on the list of anesthetic records.The time of postoperative exhaust and the time of pulling out the pelvic drainage tube after operation are based on the medical orders.The pathological condition are based on pathological list.4.Statistical methods: SPSS 19 software was used for statistical analysis.Two groups of measurement data were first tested by normality.Only both of them met the measured data of the normal distribution,they are expressed in x ±s.The two sample t test was used according to the homogeneity of variance.The measurement data of non normal distribution are expressed in the median and range.Mann-Whitney U test was used for comparison between groups.The counting data are expressed in cases and percentage.Chi square test was used for comparison between groups.The difference was statistically significant in P<0.05.Results:There was no significant difference in the general data and postoperative pathological results between the experience group and the control group(P>0.05).There was no significant difference in blood loss [65(20-300)vs70(10-400)ml,P=0.848],operative time [165(104-270)vs183(100-328)min,P=0.368] and lymph node clearance [16.288±3.262vs15.694±2.745,P=0.356] between the two groups(P>0.05).There was no significant difference between the two groups in postoperative exhaust time [6(2-12)vs6(2-18)d,P=0.253] and pelvic drainage tube drainage time [12.5(6-44)vs13(7-120)d,P=0.220](P>0.05).Postoperative anastomotic leakage occurred in 2 patients in the experience group,while anastomotic leakage(P<0.05)occurred in 14 of the control group.The patients in the two groups were followed up for one year after operation.There were no deaths in the two groups due to tumor recurrence or metastasis.There were 1 cases of local recurrence in the experimental group,and 3 cases of liver and lung metastasis.In the control group,local recurrence occurred in 2 cases,and liver and lung metastasis occurred in 4 cases.The results of the two groups were compared(P>0.05).Conclusion:The radical resection of rectal cancer with preserving left colonic artery can completely remove the third lymph nodes,and can achieve the effect of radical treatment.It is a safe and reliable operation.At the same time,it is as little as possible to change the anatomical structure,for providing the upper end anastomosis with a better blood supply,which can reduce the occurrence of anastomotic leakage and promote the recovery of gastrointestinal function.The difficulty and skill of preserving the LCA operation can be accepted by the surgeon,and it is worth promoting in the clinic.