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

Abstract

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. MethodsThis 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. ResultsIn the matched cohort, no signi cant 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 signi cantly different between the LIMA and PSRA groups (3year 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-speci c survival: 84.2% vs. 82.8%, P = 0.607). No recurrence of LN metastasis was observed around the IMA root. ConclusionLaparoscopic 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 largescale studies.