A Systematic Review Of The Effect Of Left Colonic Artery Preservation On The Prognosis Of Laparoscopic Precancerous Rectal Resection

Objectives: The effect of the left colonic artery on the prognosis of patients with low rectal precancerous resection under laparoscopy was systematically evaluated.Methods: The system searched multiple Chinese and English databases for relevant journals,conference literatures,and references of literatures on the effect of preserving the left colon artery on the prognosis of patients during laparoscopic precancerous rectal resection.The screening of the included literature,the extraction of literature data,and the evaluation of the quality of the literature were all decided by the two reviewers in accordance with the inclusion and exclusion criteria.A systematic review was performed to assess the effect of the left colonic artery on the prognosis of patients with low rectal resection.Results: 1.After reading the full text,12 clinical randomized controlled research literatures were finally included for analysis.A total of 2390 patients were included,including1423 patients in the left colon artery group and 967 patients in the left colon artery group.2.Six literatures reported whether the local recurrence and metastasis of patients with left colon artery were preserved after surgery.There was no heterogeneity between the two groups after surgery(P = 0.69,I2 = 0%).Therefore,a fixed effect model was used.The incidence of local recurrence and metastasis was higher in the patients with colonic arterial group than those without left colonic arterial group(OR = 1.02,95% CI: 0.69 ~ 1.52,P = 0.91).Sensitive analysis shows that the results are credible.Based on the results of this analysis,it can be seen that whether the left colon artery is preserved during laparoscopic low rectal resection has no significant effect on the incidence of local recurrence and metastasis.According to the funnel chart,the 6 literatures included this time are basically symmetrically distributed,and the research publication bias is relatively small.3.Seven articles reported comparison of postoperative ventricular time in patients with left colonic arteries.The two groups of patients were heterogeneous(P = 0.0002,I2 = 77%).Therefore,a random effect model was used.Patients in the group had shorter postoperative ventilator time than those without the left colon artery(OR =-0.56,95% CI:-0.90 ~-0.22,P =0.001).Sensitivity analysis was performed and fixed effects analysis was used to show that the results were credible.Based on the results of this analysis,it can be seen that the left colonic artery preservation during laparoscopic low rectal precancerous surgery has a shorter postoperative exhaust time for patients,and there is a significant difference compared with the left colonic artery preservation group.From the funnel chart,it can be seen that the 7 articles included this time are basically symmetrically distributed.Only a few documents have slight deviations,and the research publication bias is small.4.Twelve articles reported whether the anastomotic fistula occurred in patients with left colonic arteries.The two groups of patients were not heterogeneous(P = 0.03,I2 = 48%).Therefore,a random effects model was used to analyze the results.Anastomotic fistulas were less common in patients in the colon artery group than in patients without the left colon artery group(OR = 0.22,95% CI: 0.11 ~-0.46,P <0.0001).Sensitivity analysis was performed using random effects analysis to show that the results were credible.According to the results of this analysis,patients with left colonic arteries who underwent laparoscopic precancerous resection of the rectum were more likely to have an anastomotic fistula after surgery,and there was a significant difference compared with the group without left colonic arteries.According to the funnel chart,the 12 articles included this time are basically symmetrically distributed,and the research publication bias is relatively small.5.Three articles reported whether the left colonic artery was preserved in patients with postoperative sexual dysfunction.The two groups of data were relatively heterogeneous(P =0.97,I2 = 0%).Therefore,a fixed effect model was used for analysis.The results showed that There were fewer patients with sexual dysfunction in the left colon artery group than in the left colon artery group(OR = 0.15,95% CI: 0.03 ~-0.69,P = 0.01).Performing a sensitivity analysis showed that the results were credible.According to the results of this analysis,patients with left colonic arteries who underwent laparoscopic lower rectal precancerous surgery had a lower probability of postoperative occurrence,and there was a significant difference compared with the group without left colonic arteries.The 3 publications included this time have a smaller research publication bias,but because there are too few included publications,further research is needed to confirm.Conclusion: Patients with left colonic arteries who have left the rectum before rectal cancer have a better prognosis than those who do not.