Feasibility And Security Of Left Colonic Artery Preservation In Laparoscopic Radical Resection Of Rectal Cancer:A Meta-analysis

Objectives We searched for relevant studies from March 2011 to March 2021 to evaluate the feasibility and safety of preserving the left colonic artery in laparoscopic radical resection of rectal cancer through meta-analysis.Methods The search terms of "rectal cancer","left colonic artery" and "Laparoscopes" were selected,and the combination of free words and subject words was adopted.The Cochrane Library,Pubmed,Embase,CNKI,CBM,Wanfang,VIP and other databases were searched for the related articles from March 2011 to March 2021,and the related studies on whether the left colonic artery was preserved or not in the laparoscopic radical resection for rectal cancer were collected.Two professional clinical researchers independently performed literature screening,Meta extraction,and article quality evaluation.Finally,the software Revman5.2 was used to conduct a meta-analysis on the 14 outcome indicators including the incidence of postoperative anastomotic leakage,the incidence of intraoperative preventive ostomy,the incidence of postoperative urination dysfunction,the time of postoperative first exhaust,the operation time,the amount of bleeding during the operation,the total number of intraoperative lymph node dissection,the number of No.253 lymph node dissection,the number of positive cases of No.253 lymph node,the incidence of postoperative intestinal obstruction,the hospitalization days,the recurrence,the postoperative metastasis and the five-year survival rate after the operation.If the results showed large heterogeneity,the sensitivity analysis of the outcome indicator was continued to verify the stability of the results.Results A total of 21 articles were included in this study,with a total of 3,849 patients.Meta-analysis results indicated that Compared with the left colonic artery nonpreservation group,although the operation time is prolonged,and no obvious advantage is seen,the preservation group can remarkably reduce the incidence rate of postoperative anastomotic leakage(OR=0.47,95%CI:0.36-0.61,P<0.05),the incidence of intraoperative preventive ostomy(OR=0.56,95%CI:0.39-0.80,P<0.05),and the incidence of postoperative urination dysfunction(OR=0.61,95%CI:0.39-0.96,P<0.05),total number of lymph node dissection(MD=-0.38,95%CI:-0.70--0.06,P<0.05),and first postoperative exhaust time(MD =-0.32,95% CI:-0.47--0.18,P<0.05).There were no significant differences in the amount of intraoperative bleeding,the number of No.253 lymph node dissection,the number of No.253 positive cases,the length of hospital stay,the incidence of postoperative intestinal obstruction,postoperative recurrence,postoperative metastasis and the five-year survival rate(P>0.05).Conclusion It is safe and feasible to preserve left colonic artery in laparoscopic radical resection of rectal cancer.Figure17;Table1;Reference 167.