Safety, Survival, and Efficacy of Preserving Left Colonic Artery in Rectal Cancer Surgery: A Meta-Analysis and Review

Cui, YongHe; Sun, ShaoMing; Li, Zhanwu; Wang, Wenjun

doi:10.1089/lap.2019.0406

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Numerous previous studies have explored the reasons for AL after anterior resection of rectal carcinoma and performed many measures to reduce its incidence, including preventive diverting stoma, intracorporeal reinforcing sutures, preservation of the left colonic artery, placement of a transanal tube, and mobilization of the splenic flexure of the colon to decrease the tension on the anastomosis [11][12][13][14][15][16]. Moreover, several scoring systems and prediction models have been built to predict the occurrence of AL [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

Wang

Liu

2020

Gastroenterology Research and Practice

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Background. Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods. This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results. In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P=0.047), intraoperative chemotherapy (P=0.003), and level of anastomosis (P=0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P=0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P=0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P=0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

Wang

Liu

2020

Gastroenterology Research and Practice

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“…The blood supply around the anastomosis [12,13], the integrity of the anastomosis [14,15], and the tension of the anastomosis [16,17], these three aspects are generally recognized as high risk factors of anastomotic leakage. The advantages of the PST technique facilitated to improve the blood supply of the anastomosis, reinforce the integrity of the anastomosis with free or lower tension: (1) Decreased incidence of AL after left colonic artery preservation have not been proved by randomized studies [28], but recent metaanalyses indicated that left colonic artery preservation is associated with lower risk of AL after LAR [29,30]. With the progressive increase in the aging population, vascular disease can be a factor contributing to insufficient blood supply [13].…”

Section: Discussionmentioning

confidence: 99%

A trinity technique for prevention of low rectal anastomotic leakage in the robotic era

Chang

et al. 2020

European Journal of Surgical Oncology

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“…Preserving the left colonic artery (LCA) during laparoscopic anterior rectal resection can improve blood supply to the proximal intestine of the anastomosis. LCA preservation is particularly important in patients undergoing low or ultralow anterior resection, helping to reduce the incidence of postoperative anastomotic fistula ( 1 ). Increasing clinical evidence shows that thorough lymph node dissection in the inferior mesenteric artery (D3) at the base of the inferior mesenteric artery (IMA), while preserving the LCA, will not affect the effect of tumour radical treatment or affect the long-term postoperative survival of patients ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy and clinical variation of the left colonic artery in laparoscopic anterior rectal resection

Li,

Zhao,

et al. 2024

Front. Surg.

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ObjectivesThis study aims to investigate the surgical anatomy and clinical variation of the left colonic artery (LCA) during laparoscopic anterior rectal resection.MethodsWe conducted a retrospective analysis of 87 patients diagnosed with colorectal cancer who underwent laparoscopic anterior rectal resection with preserved LCA at the Department of Gastroenterology, Sichuan Cancer Hospital, between March 2018 and April 2022, aiming to observe the emanation location, anatomical typing, and travel trajectory of the LCA, as well as its relationship with the inferior mesenteric vein (IMV).ResultsIn all observed cases, we observed that the LCA emanated from the left side of the inferior mesenteric artery (IMA), and the average distance from the root of the IMA to the emanation of the LCA was approximately 3.5 ± 1.1 cm. Specifically, 35 of these cases had the LCA branching from the IMA alone (Type I, 40.2%),16 cases had the LCA cotruncating with the sigmoid artery (SA) (Type II, 18.4%), 30 cases had the LCA cotruncating with the superior rectal artery (SRA) and SA (Type III, 34.5%), and six cases had the LCA cotruncating with four or more branches of the SRA and SA (Type IV, 6.9%). No LCA agenesis cases were found in this group. In addition, we also observed the occurrence of LCA alignment. Specifically, there were 25 cases where the LCA crossed the IMV in a diagonal upward direction (Type A, 28.7%), 36 cases where the LCA crossed the IMV in an upward arched manner (Type B, 41.4%), 18 cases where the LCA crossed the IMV in a vertical outward direction (Type C, 20.7%), and eight cases where the LCA crossed the IMV in a diagonal downward manner (Type D, 9.2%). Among them, two cases developed anastomotic fistula, one case had chyle leakage 1 week after surgery, and four cases experienced urinary retention; all of the patients successfully recovered and were discharged after receiving conservative treatment.ConclusionThe anatomy and variation of the LCA can be clearly and accurately observed during laparoscopic surgery. Understanding the type and variation of the LCA helps to dissect the vessels in the IMA region during surgery, particularly in cases when the LCA is preserved, and reduce the incidence of vascular injury and its complications.

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Safety, Survival, and Efficacy of Preserving Left Colonic Artery in Rectal Cancer Surgery: A Meta-Analysis and Review

Cited by 8 publications

References 26 publications

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

A trinity technique for prevention of low rectal anastomotic leakage in the robotic era

Surgical anatomy and clinical variation of the left colonic artery in laparoscopic anterior rectal resection

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