Short- and long-term outcomes of preservation of the superior rectal artery versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: a propensity score-matched analysis

Abstract

Purpose This study aimed to compare the short- and long-term outcomes of laparoscopic D3 lymph node (LN) dissection between ligation of the inferior mesenteric artery (IMA) (LIMA) and preservation of the superior rectal artery (SRA) (PSRA) for descending colon cancer using propensity score-matched analysis. Methods This retrospective study included 101 patients with stage I-III descending colon cancer who underwent laparoscopic D3 LN dissection with LIMA (n = 60) or PSRA (n = 41) at a single center between January 2005 and March 2022. After propensity score matching, 64 patients (LIMA, n = 32; PSRA, n = 32) were included in the analysis. The primary endpoint was the long-term outcomes, and the secondary endpoint was the surgical outcomes. Results In the matched cohort, no significant difference was noted in surgical outcomes, included the operative time, estimated blood loss, number of harvested LNs, number of harvested LN 253, and complication rate. The long-term outcomes were also not significantly different between the LIMA and PSRA groups (3-year recurrence-free survival: 78.7% vs. 88.9%, P = 0.335; 5-year overall survival: 69.8% vs. 63.4%, P = 0.888; 5-year cancer-specific survival: 84.2% vs. 82.8%, P = 0.607). No recurrence of LN metastasis was observed around the IMA root. Conclusion Laparoscopic D3 dissection in PSRA was comparable to that in LIMA regarding both short- and long-term outcomes. The optimal LN dissection for descending colon cancer should be investigated in future large-scale studies.