Clinical Effect Of Preservation Or Non-preservation Of Left Colic Artery In Total Mesorectal Excision Under Laparoscopy: A Meta-analysis

Purpose:To investigate the clinical effect of preservation or non-preservation of left colic artery(LCA)in total mesorectal excision under laparoscopy.Methods:The words "rectal cancer","left colonic artery","laparoscopy","rectal","laparoscopic",and "left colic artery" were used as the retrieval terms,and the keyword retrieval method was adopted.The retrieval period was set as from January 01,2013 to June 1,2018.We searched databases including PubMed,Web of Science,China National Knowledge Infrastructure(CNKI),Vip and Cochran to collect randomized and controlled trials which compared the effect of preservation or non-preservation of the LCA in total mesorectal excision under laparoscopy.Two researchers independently carried out literature screening,data extraction,and literature quality evaluation;Review Manager 5.3 was used for the meta-analysis.Results:A total of 43 related articles were obtained,among which 7articles that met the inclusion criteria were finally included.As showed by the meta-analysis,compared with the LCA-non-preservation group,the LCA-preservation group had significantly reduced incidence of anastomotic leakage(OR = 0.44,95%CI = [0.30,0.65],P <0.0001)and postoperative urinary and sexual dysfunction(OR = 0.26,95%CI = [0.09,0.78],P = 0.02),and significantly shorter time for intestinal function recovery(WMD =-0.26,95%CI = [-0.41,-0.11],P = 0.0008).There were no significant differences between the two groups in tumor recurrence,the duration of surgery,blood loss,number of dissected lymph nodes,tumor recurrence,or Postoperative hospital stay.Conclusion:Preservation of the LCA in total mesorectal excision under laparoscopy can reduce the incidence of anastomotic leakage and postoperative urinary and sexual dysfunction,and shorten the time for intestinal function recovery.There were no significant differences between the two groups in the duration of surgery,intraoperative bloodloss,number of dissected lymph nodes,tumor recurrence and Postoperative hospital stay.Therefore,this surgical method is recommended in clinical practice.