Long-term oncological outcomes of low anterior resection for rectal cancer with and without preservation of the left colic artery: a retrospective cohort study

Luo, Yuqi; Li, Rongjiang; Wu, Deqing; Zeng, Jun; Wang, Junjiang; Chen, Xianzhe; Huang, Chengzhi; Yong, Li; Yao, Xueqing

doi:10.1186/s12885-021-07848-y

Cited by 12 publications

(6 citation statements)

References 38 publications

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“…Research revealed no evidence showing the benefits of high-ligation in long-term prognosis, although it could get more lymph nodes dissected (36). Many current studies have suggested that there were no more lymph nodes dissected by high-ligation, and still, no superiority was demonstrated in long-term prognosis compared to lowligation (37)(38)(39)(40)(41). There were no statistical differences between the total number of lymph nodes dissected and the number of positive ones.…”

Section: Discussionmentioning

confidence: 96%

High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections: A retrospective study

Chen

et al. 2023

Front. Surg.

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BackgroudThe high or low inferior mesenteric artery (IMA) ligation in rectal cancer remains a great debate. This study retrospectively discussed the outcomes of the perioperative period, defecation and urinary function and long-term prognosis in rectal cancer patients with high or low IMA ligation.MethodsThis study enrolled 220 consecutive rectal cancer cases, including 134 with high IMA ligation and 86 with low ligation. A comparison between the two groups was made for anastomotic leakage, low anterior resection syndrome (LARS), international prostate symptom score (IPSS), 5-year disease-free survival (DFS) and 5-year overall survival (OS).ResultsLow-ligation group had a longer operative time, and larger intraoperative blood loss. No significant difference was noted in anastomotic leakage incidence. In multivariable analysis, the male gender and tumor located at the lower rectum were identified as risk factors for anastomotic leakage. No significant differences were observed between groups in their LARS and IPSS questionnaire responses. The high-ligation vs. the low-ligation 5-year OS and DFS were 78.3% vs. 82.4% and 72.4% vs. 76.6%, respectively, which were not statistically different.ConclusionThe ligation level of the IMA had no significant effect on the anastomotic leakage incidence, defecation, urinary function, and long-term prognosis.

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Section: Discussionmentioning

confidence: 96%

High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections: A retrospective study

Chen

et al. 2023

Front. Surg.

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“…Proponents of LCA nonpreservation believe that this method could help clear apical LNs and ensure the accuracy of tumor staging [ 25 ]. However, there is no strong evidence that high ligation of the IMA with LCA nonpreservation has apparent benefit for patients [ 15 , 26 , 27 ]. Theoretically, harvested LNs and oncological outcomes are not expected to be impaired after preservation of the LCA, as long as the procedure is complemented by dissection of the apical LNs around the IMA root.…”

Section: Discussionmentioning

confidence: 99%

Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis

Zheng

Xie

et al. 2022

BMC Surg

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Background Preserving the left colic artery (LCA) during anterior resection for rectal cancer is controversial, and robust evidence of the outcomes of LCA preservation plus apical lymph node dissection is lacking. The purpose of this study was to investigate the impact of LCA preservation plus apical lymph node dissection surgery on anastomotic leakage and number of harvested lymph nodes. Methods Patients who underwent laparoscopic or robotic anterior resection for rectal cancer between September 2017 and May 2020 were retrospectively assessed. The patients were categorized into two groups: preservation of LCA and nonpreservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was anastomotic leakage within 30 days after surgery. The secondary outcomes were number of harvested lymph nodes, 3-year overall survival, and 3-year disease-free survival. Results A total of 216 patients were eligible for this study, and propensity score matching yielded 60 patients in each group. Anastomotic leakage in the LCA preservation group was significantly lower than that in the LCA nonpreservation group (3.3% vs. 13.3%, P = 0.048). No significant differences were observed in blood loss, operation time, intraoperative complications, splenic flexure mobilization, total number of harvested lymph nodes, number of positive lymph nodes, time to first flatus, or postoperative hospital stay. Kaplan–Meier survival analysis showed a 3-year disease-free survival of 85.7% vs. 80.5% (P = 0.738) and overall survival of 92.4% vs. 93.7% (P = 0.323) for the preservation and nonpreservation groups, respectively. Conclusion LCA preservation plus apical lymph node dissection surgery for rectal cancer may help reduce the incidence of anastomotic leakage without impairing the number of harvested lymph nodes. Preliminary results suggest that 3-year disease-free survival and overall survival rates may not differ between the two types of surgery, but studies with larger sample sizes are needed to confirm these conclusions. Trial registration ClinicalTrials.gov, NCT03776370. Registered 14 December 2018—Retrospectively registered, https://clinicaltrials.gov.

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“…One patient finally chose to give up treatment due to family problems. Some studies have shown that preserving the left colonic artery does not increase the overall recurrence rate and reduce the overall survival rate, and there is no significant difference in long-term survival [14,15].…”

Section: Discussionmentioning

confidence: 99%

Preservation of the left colic artery in modified laparoscopic anterior rectal resections without auxiliary abdominal incisions for transanal specimen retrieval

Liu

et al. 2022

BMC Surg

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Background Laparoscopic low anterior rectal resection is the most widely used surgical procedure for middle and low rectal cancer. The aim of this study was to investigate the feasibility and safety of the extracorporeal placement of the anvil in preserving the left colic artery in laparoscopic low anterior rectal resection without auxiliary incisions for transanal specimen retrieval in this research. Methods Clinical data and follow-up data of patients undergoing laparoscopic low anterior rectal resection from January 2017 to October 2020 were collected. The resections were modified such that the resisting nail holder was extracorporeally placed for the transanal exenteration of the specimen without using auxiliary abdominal incisions while preserving the left colic artery. By analyzing the data of anastomotic stenosis, anastomotic bleeding and anastomotic fistulas after surgery, the advantages and disadvantages of this surgical method for patients were clarified. Results A total of 22 patients were enrolled. Five of 22 patients simultaneously underwent double-barrel terminal ileostomy. The postoperative exhaust time was 2–7 (median, 3) days. Postoperative anastomotic bleeding occurred in one patient, postoperative anastomotic fistula occurred in four patients, and postoperative anastomotic stenosis occurred in six patients. There were four patients with postoperative distant metastasis, of which three had concomitant local recurrence. Seventeen patients had no obvious symptoms or signs of recurrent metastases during follow-up appointments, and one died of liver failure. Conclusions Modified laparoscopic low anterior rectal resection, which resects the specimen through anus eversion by inserting the anvil extracorporeally while preserving the left colic artery, is safe and feasible for patients with low rectal cancer.

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Long-term oncological outcomes of low anterior resection for rectal cancer with and without preservation of the left colic artery: a retrospective cohort study

Cited by 12 publications

References 38 publications

High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections: A retrospective study

High and low inferior mesenteric artery ligation in laparoscopic low anterior rectal resections: A retrospective study

Preservation versus nonpreservation of the left colic artery in anterior resection for rectal cancer: a propensity score-matched analysis

Preservation of the left colic artery in modified laparoscopic anterior rectal resections without auxiliary abdominal incisions for transanal specimen retrieval

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