Marginal artery stump pressure in left colic artery‐preserving rectal cancer surgery: a clinical trial

Guo, Yuchen; Wang, Daguang; He, Liang; Zhang, Yang; Zhao, Shuhong; Zhang, Luyao; Sun, Xuan; Suo, Jian

doi:10.1111/ans.13032

Cited by 73 publications

(96 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When further analysis of stage-by-stage OS rates and DFS rates in stage I to stage III cases, there was still no statistically signi cant difference in OS and DFS rates between the LCA preservation group and the LCA non-preservation group in all stage I to stage III. Several previous studies have also shown that, whether preserving LCA or not, there were no signi cant differences with respect to the 5-year mortality in patients underwent laparoscopic rectal cancer, and it seemed to achieve comparable success with acceptable safety outcomes [7][8][9], but data from JCOG0404 showed that preserving LCA, ve-year relapse-free survival and OS tended to be better in the LCA preservation group than the LCA non-preservation group Kaplan-Meier estimates of overall survival and disease-free survival for all anterior resection cases (a and b, respectively). The red line and the green line indicate, respectively, survival curves of the LCA preservation group and the LCA nonpreservation group.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Luo¹,

Li²,

Wu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Aim To analyze the effect of preserving the left colic artery (LCA) on long-term oncologic outcomes during laparoscopic low anterior resection of rectal cancer. Methods Clinicopathological and follow-up patients undergoing laparoscopic low anterior resection of rectal cancer in general surgery department of Guangdong Provincial People's Hospital from January 2014 to December 2015 were retrospectively collected. According to the difference surgical methods of inferior mesenteric artery (IMA), 159 cases were divided into the LCA preservation group and 225 cases in the LCA non-preservation group. The 5-year rates of overall survival (OS) and disease-free survival (DFS) were compared between two group. Results 384 patients were included in final analysis. Anastomotic leakage occurred in 7 patients (4.4%) in the LCA preservation group and in 16 patients (7.1%) in the LCA non-preservation group. The follow-up rate was 91.2% (145/159) during 5–60 months in LCA preservation group, and 89.8% (202/225) during 5–60 months in the LCA non-preservation group. The number of patients who developed death, local recurrence and metastasis were 59 (37.1%), 13 (8.2%) and 60 (37.7%) in the LCA preservation group, and 86 (38.2%), 20 (8.9%) and 92 (40.9%) in the LCA non-preservation group, without significant differences (all P ༞ 0.05). The 5-year OS and DFS rates were 69.0% and 59.3% in the LCA preservation group, and 68.8% and 55.9% in the LCA non-preservation group, without significant differences (all P ༞ 0.05). After stratification by TNM Stage, the difference on 5-year OS rates and DFS rates of I stage, II stage and III stage in two groups were no significant as well (all P ༞ 0.05). Conclusions The long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the LCA are comparable with ligation at origin of IMA.

show abstract

Section: Discussionmentioning

confidence: 97%

“…Retrospective studies suggested that preserving the left colic artery may reduce the incidence of anastomose-related complications but had no effect on the long-term oncologic outcomes [7][8][9]. Nevertheless, preserving the LCA or not during laparoscopic low anterior resection of rectal cancer, is still debated.…”

Section: Introductionmentioning

confidence: 99%

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Luo¹,

Li²,

Wu³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Further, patients who underwent further ''re-resection'' up to a ''fluorescent'' portion due to insufficient bowel perfusion in this study were those with left colectomies. With regard to the reason, previous studies found the blood pressure of marginal artery was reduced by ≥30% after the blockage of the left colic artery and unstable blood flow to the left colon occurred after IMA ligation in approximately 10% of patients, which could increase the rate of insufficient perfusion [26][27] . Therefore, we confirmed that insufficient perfusion of the bowel may more frequently occur in patients with left colon cancer, and we should focus more on the bowel perfusion in totally laparoscopic left hemicolectomy, especially for the proximal margin.…”

Section: Postoperative Recovery and Complicationsmentioning

confidence: 99%

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

Mandula

et al. 2020

Preprint

View full text Add to dashboard Cite

Aim: To retrospectively evaluate the feasibility and safety of intraoperative assessment of bowel perfusion in totally laparoscopic surgery for colon cancer using indocyanine green fluorescence imaging (IGFI).Methods: From October 2017 to June 2019, consecutive patients with colon cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the IGFI group (n=84) and control group (n=105). In the IGFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.Results: The two groups were demographically comparable. The IGFI group exhibited a significantly shorter operative time (p=0.0374) while intraoperative blood loss did not significantly differ among the groups (p=0.062). In the IGFI group, average time to perfusion fluorescence was 48.4±14.0 s after ICG injection, and four patients (4.8%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected. There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (p＞0.05). Conclusion: IGFI shows promise as a safe and feasible tool to assess bowel perfusion during a totally laparoscopic surgery for colon cancer and may reduce the operative time.

show abstract

“…after the blockage of the left colic artery and unstable blood flow to the left colon occurred after IMA ligation in approximately 10% of patients, which could increase the rate of insufficient perfusion [22][23] . Therefore, we confirmed that insufficient perfusion of the bowel may more frequently occur in patients with left colon cancer, and we should focus more on the bowel perfusion in totally laparoscopic left hemicolectomy, especially for the proximal margin.…”

Section: Postoperative Recovery and Complicationsmentioning

confidence: 99%

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

Mandula

et al. 2020

Preprint

View full text Add to dashboard Cite

Aim: To retrospectively evaluate the feasibility and safety of intraoperative assessment of bowel perfusion in totally laparoscopic surgery for colon cancer using indocyanine green fluorescence imaging (IGFI). Methods: From October 2017 to June 2019, consecutive patients with colon cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the IGFI group (n=84) and control group (n=105). In the IGFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis. Results: The two groups were demographically comparable.The IGFI group exhibited a significantly shorter operative time (p=0.0374) while intraoperative blood loss did not significantly differ among the groups (p=0.062). In the IGFI group, average time to perfusion fluorescence was 48.4±14.0 s after ICG injection, and four patients (4.8%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected. There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (p 0.05). Conclusion: IGFI shows promise as a safe and feasible tool to assess bowel perfusion during a totally laparoscopic surgery for colon cancer and may reduce the operative time.

show abstract

Marginal artery stump pressure in left colic artery‐preserving rectal cancer surgery: a clinical trial

Abstract: Low ligation with apical lymph node dissection in rectal cancer treatment provides better anastomotic blood supply but is not associated with differences in node retrieval rate or operation time.

Cited by 73 publications

References 23 publications

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

Contact Info

Product

Resources

About