Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis

Si, Moubo; Yan, Peijing; Du, Zhen-Ying; Li, Laiyuan; Tian, Hongwei; Jiang, Wenjie; Jing, Wutang; Yang, Jia; Han, Caiwen; Shi, Xiue; Yang, Kehu; Guo, Tiankang

doi:10.1007/s00384-019-03291-5

Cited by 45 publications

(64 citation statements)

References 42 publications

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“…No significant difference was found in the total number of lymph nodes removed or the long-term survival rate (5-year OS and 5-year DFS) between the two groups, in agreement with previous studies 3,9,15,16,23,29,30 . The modified low ligation method is different from the traditional method and does not reduce the range of lymph node dissection.…”

Section: Discussionsupporting

confidence: 92%

“…By contrast, low ligation ensures adequate blood supply to the proximal limb of the anastomosis due to the retention of the LCA. Several reviews 9,23 have also shown that low ligation is associated with a lower rate of anastomotic leakage. The slightly longer operation time in the improved low -ligation group may reflect the increased operational complexity.…”

Section: Discussionmentioning

confidence: 99%

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Short- and long-term outcomes of rectal cancer patients with high or improved low ligation of the inferior mesenteric artery

Zhang

Chen

Cui

et al. 2020

Sci Rep

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The ligation site of the inferior mesenteric artery (IMA) during laparoscopic radical resection for rectal cancer has been controversial. Consecutive patients (n = 205) with rectal cancer who underwent laparoscopic-assisted low anterior resection from January 2009 to December 2015 were retrospectively analyzed. The patients were divided into high ligation (n = 126) and improved low ligation groups (n = 79). A total of 205 rectal cancer patients underwent laparoscopic assisted anterior resection: 126 patients in the high ligation group and 79 patients in the improved low ligation group. The improved low ligation group was better than the high ligation group in terms of postoperative flatus time and postoperative defecation time. There were no differences between the groups in terms of blood loss, operation time, total number of lymph nodes, anastomotic leakage, postoperative time to first liquid diet and postoperative hospital stay. There were also no differences in 5-year overall survival (OS). Compared to high ligation, the improved low ligation ensures the extent of lymph node dissection, and promotes the early recovery of postoperative gastrointestinal function, but does not increase the operation time, bleeding risk, or anastomotic leakage. A ligation site of the IMA in laparoscopic rectal cancer surgery may not influence oncological outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Short- and long-term outcomes of rectal cancer patients with high or improved low ligation of the inferior mesenteric artery

Zhang

Chen

Cui

et al. 2020

Sci Rep

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“…In comparison, direct ligation of the LCA during surgery is easier, with downregulated di culty of separating blood vessels, which enables operators to perform the surgery more e ciently and conveniently. A higher incidence of urinary dysfunction is reportedly associated with LCA non-preservation surgery in CRC [8], but no statistical difference was found in our study. The related nerve is located around the root of the IMA and could be preserved from damage if dissection and ligation were done carefully 1-2 cm away from the root of the aorta.…”

Section: Discussioncontrasting

confidence: 92%

“…Although some excellent meta-analyses have been published in the past few years, the optimal procedure for CRC in handling the LCA remains controversial [8][9][10][11][12][13]. To our knowledge, no published meta-analysis has compared the preservation and non-preservation of the LCA in RC alone.…”

Section: Discussionmentioning

confidence: 99%

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

Wang

et al. 2020

Preprint

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Background: Left colic artery (LCA) preservation or non-preservation in radical resection for colorectal cancer is still under debate. This study aimed to compare the perioperative and oncological outcomes between the two procedures.Methods: Systematic search was performed in PubMed, Medline, Embase, Web of Science, and China National Knowledge Infrastructure databases for relevant randomized and non-randomized clinical trials published between 2011 and 2019. The primary endpoints were 5-year overall survival (OS), 5-year disease-free survival (DFS), total lymph nodes harvested, and anastomotic leakage. Secondary endpoints included the number of metastatic lymph nodes, intraoperative blood loss, urinary dysfunction, bowel obstruction, and operation time. Results: Twenty-eight studies with 10545 patients (LCA non-preservation surgery, 4920; LCA preservation surgery, 5625) were included. Data of 7142 rectal cancer patients (LCA non-preservation surgery, 3468; LCA preservation surgery, 3674) were extracted for subgroup analysis. There was significantly lower incidence of anastomotic leakage (odds ratio=1.21; 95% confidence interval |1.04, 1.41|; P=0.015) in colorectal cancer patients with LCA preservation. When rectal cancer was independently analyzed, no significant difference was found in anastomotic leakage between the groups. There were significantly more metastatic lymph nodes and significantly shorter operation time in colorectal cancer and rectal cancer patients with LCA non-preservation. No significant difference was found regarding 5-year OS, 5-year DFS, total lymph nodes harvested, intraoperative blood loss, urinary dysfunction, and bowel obstruction for colorectal and rectal cancer.Conclusions: LCA non-preservation was not proved to increase anastomotic leakage in rectal cancer surgery and was associated with more harvested metastatic lymph nodes and shorter operation time. Trial registration: A review protocol was registered on PROSPERO (registration number: CRD42020183906) and http://www.researchregistry.com (registration number: reviewregistry841).

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“…Colorectal cancer (CRC) has become a common malignancy that is well known for its poor survival outcomes and advanced metastasis 1‐3 . Apart from environmental factors such as obesity, diet, and physical inactivity, 4‐6 genetic and epigenetic alternations have been well‐recognized as risk factors in CRC etiology 7‐10 …”

Section: Introductionmentioning

confidence: 99%

MAGI2‐AS3 rs7783388 polymorphism contributes to colorectal cancer risk through altering the binding affinity of the transcription factor GR to the MAGI2‐AS3 promoter

Yang

et al. 2020

Clinical Laboratory Analysis

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Background It has been indicated that the single nuclear polymorphisms (SNPs) in the long noncoding RNA (lncRNA) have association with colorectal cancer (CRC) susceptibility. Methods We enrolled 1078 cases with CRC and 1175 age‐ and gender‐matched cancer‐free controls to explore whether the polymorphisms in MAGI2‐AS3 have associations with CRC risk. qRT‐PCR, expression quantitative trait loci (eQTL) analyses, dual‐luciferase reporter assay, chromatin immunoprecipitation (ChIP), flow cytometry, and transwell assays were performed to explore the specific mechanisms in which MAGI2‐AS3 rs7783388 variation influenced the tumorigenesis of CRC. Results Subjects carrying rs7783388 GG genotype presented a higher risk of CRC compared with the AG/AA genotypes. Mechanistically, we found that the functional genetic variant of rs7783388 A > G decreased binding affinity of transcription factor glucocorticoid receptor (GR) to the MAGI2‐AS3 promoter, resulting in decreased transcriptional activity that subsequently downregulated MAGI2‐AS3 expression. Furthermore, functional experiments elucidated that MAGI2‐AS3 overexpression suppressed CRC cell proliferation, migration, and invasion capacities, arrested cell cycle at G0/G1 phase, and promoted cell apoptosis. Conclusion Taken together, our study demonstrated that the potential function of MAGI2‐AS3 as a tumor suppressor for CRC, and the MAGI2‐AS3 rs7783388 polymorphism is associated with the increased susceptibility to CRC by altering the binding ability of GR to the MAGI2‐AS3 promoter.

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Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis

Cited by 45 publications

References 42 publications

Short- and long-term outcomes of rectal cancer patients with high or improved low ligation of the inferior mesenteric artery

Short- and long-term outcomes of rectal cancer patients with high or improved low ligation of the inferior mesenteric artery

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

MAGI2‐AS3 rs7783388 polymorphism contributes to colorectal cancer risk through altering the binding affinity of the transcription factor GR to the MAGI2‐AS3 promoter

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