Impact of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Sigmoid Resection and Anterior Resection for Sigmoid and Rectosigmoid Colon Cancer

Kato, Hisaki; Munakata, Shinya; Sakamoto, Kazuhiro; Sugimoto, Kiichi; Yamamoto, Riku; Ueda, Shuhei; Tokuda, Satoshi; Sakuraba, Shunsuke; Kushida, Tomoyuki; Orita, Hajime; Sakurada, Mutsumi; Maekawa, Hiroshi; Sato, Koichi

doi:10.1007/s12029-018-0126-z

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…A multicenter study also suggested that preservation of the LCA during laparoscopic AR for middle and low rectal cancers is associated with lower AL rates (7.4% vs 13.2%, P = 0.005)[ 34 ]. Several others studies have reported the same conclusion[ 35 - 37 ]. Our study also suggested a statistically higher rate of AL and diverting stoma in the HL group (10.2% vs 2.6%, P = 0.001; 16.5% vs 7.5%, P = 0.003, respectively).…”

Section: Discussionsupporting

confidence: 73%

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Chen

Liu

Wang

et al. 2020

WJGO

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BACKGROUND For laparoscopic rectal cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin from the aorta [high ligation (HL)] or distally to the origin of the left colic artery [low ligation (LL)]. Whether different ligation levels are related to different postoperative complications, operation time, and lymph node yield remains controversial. Therefore, we designed this study to determine the effects of different ligation levels in rectal cancer surgery. AIM To investigate the operative results following HL and LL of the IMA in rectal cancer patients. METHODS From January 2017 to July 2019, this retrospective cohort study collected information from 462 consecutive rectal cancer patients. According to the ligation level, 235 patients were assigned to the HL group while 227 patients were assigned to the LL group. Data regarding the clinical characteristics, surgical characteristics and complications, pathological outcomes and postoperative recovery were obtained and compared between the two groups. A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage (AL). RESULTS Compared to the HL group, the LL group had a significantly lower AL rate, with 6 (2.8%) cases in the LL group and 24 (11.0%) cases in the HL group ( P = 0.001). The HL group also had a higher diverting stoma rate (16.5% vs 7.5%, P = 0.003). A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL (OR = 3.599; 95%CI: 1.374-9.425; P = 0.009), tumor located below the peritoneal reflection (OR = 2.751; 95%CI: 0.772-3.985; P = 0.031) and age (≥ 65 years) (OR = 2.494; 95%CI: 1.080-5.760; P = 0.032) were risk factors for AL. There were no differences in terms of patient demographics, pathological outcomes, lymph nodes harvested, blood loss, hospital stay and urinary function ( P > 0.05). CONCLUSION In rectal cancer surgery, LL should be the preferred method, as it has a lower AL and diverting stoma rate.

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Section: Discussionsupporting

confidence: 73%

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Chen

Liu

Wang

et al. 2020

WJGO

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“…[6] It has been suggested that the incidence of anastomotic leakage after rectal cancer surgery is related to the level of ligation of the IMA [7]. Several studies [8][9][10][11] have conflicting reports on the impact of LCA preservation on anastomotic leakage in anterior resection for rectal cancer. The use of the high ligation may provide a greater number of lymph nodes(LNs) available for histopathological examination.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, preservation of the LCA during radical resection of rectal cancer has attracted increasing attention [11,16]. Low ligation with apical LNs dissection in rectal cancer treatment provides better anastomotic blood supply but is not associated with differences in LNs retrieval rate and operation time [17].…”

Section: Introductionmentioning

confidence: 99%

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Zheng

Tian

et al. 2020

Preprint

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Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

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“…Anastomotic leakage (AL) is a severe complication of anterior resection for rectal cancer, with an incidence varying from 3.5% to 17.4% [1–3]. Some studies [4,5] consider high ligation (HL) of the inferior mesenteric artery (IMA) as a risk factor for AL.…”

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confidence: 99%

High ligation of the inferior mesenteric artery in anterior resection for rectal cancer—a video vignette

2021

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Impact of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Sigmoid Resection and Anterior Resection for Sigmoid and Rectosigmoid Colon Cancer

Abstract: Based on the results obtained by performing laparoscopic operation for sigmoid colon cancer and rectosigmoid cancer, the LCA preservative procedure is warranted for prevention of AL.

Cited by 10 publications

References 17 publications

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

High ligation of the inferior mesenteric artery in anterior resection for rectal cancer—a video vignette

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