Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study

Fujii, Satoshi; Ishibe, Atsushi; Ota, Mitsuyoshi; Suwa, Hirokazu; Watanabe, Jun; Kunisaki, Chikara; Endo, Itaru

doi:10.1007/s00464-018-6363-1

Cited by 58 publications

(72 citation statements)

References 32 publications

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“…Details of the included studies were collected (Table 1). Seven RCTs [18][19][20][21][22][23][24], 19…”

Section: Study Characteristicsmentioning

confidence: 99%

“…RC/PC studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], and two CC studies [44,45] published between 2011 and 2019 were analyzed, investigating 10,545 patients (including 4920 patients who underwent LCA non-preservation surgery and 5625 patients who underwent LCA preservation surgery) (CRC group). Additionally, 18 studies on RC alone (including 7 RCTs [18][19][20][21][22][23][24] and 11 RC/PC studies [25, 26, 28, 30-32, 35, 38, 39, 42, 43]) with 7142 patients (including 3468 patients who underwent LCA non-preservation surgery and 3674 who underwent LCA preservation surgery) were extracted for the subgroup analysis (RC group). Studies were assessed using the Cochrane and NOS scoring systems.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five RCTs have an unclear risk of bias [19,20,[22][23][24], and two had a high risk of bias [18,21]. In the RCT by Fujii et al [18], the blinding of participants, personnel, and outcome assessors was not performed, and the RCT by Matsuda et al [21] lacked the blinding of outcome assessment and had a high risk of bias. The other ve studies did not adequately describe the allocation sequence concealment or lacked the blinding of participants, personnel, and outcome assessors.…”

Section: Study Characteristicsmentioning

confidence: 99%

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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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“…Details of the included studies were collected (Table 1). Seven RCTs [18][19][20][21][22][23][24], 19…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Comparative randomized as well as no randomized trials have failed to show the superiority of a “high tie” in terms of LN harvest and OS [43-46]. Moreover, proximal ligation of the inferior mesenteric artery may compromise the blood supply to the proximal colon and increase the risk of anastomotic leakage [47].…”

Section: Clinical Studies Comparing the Extent Of Lymphadenectomymentioning

confidence: 99%

Biology-Based Surgery: The Extent of Lymphadenectomy in Cancer of the Colon

Willaert¹,

Cosyns²,

Ceelen³

2018

Eur Surg Res

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The progression of colon cancer (CC) involves hematogenous and lymphatic spread to locoregional lymph nodes (LN), distant LN, and metastatic sites including the liver. The biological mechanisms that govern CC progression remain elusive. The Halsted model assumes an orderly, stepwise progression from the primary tumor to nearby nodes, henceforth to anatomically more distant nodes, and ultimately to distant organs. The Fisher model, on the other hand, regards the release of metastatic cells as early and essentially random events. The underlying biology has important implications for the ideal extent of surgery: when the Fisher model is correct, efforts to remove apical (central), extramesenteric, or para-aortic LN are unlikely to affect the oncological outcome. Recent data from phylogenetic studies suggest that cancer cell populations differ genetically among different LN stations and from distant metastases. Circulating tumor cells and other liquid biomarkers can be detected in the circulation of patients with early-stage disease. Local recurrence in CC is uncommon, and it is associated with a high risk of systemic progression and poor survival. Clinical studies comparing standard colectomy with extensive surgery (high ligation of the inferior mesenteric artery, complete mesocolic excision, D3 dissection, and para-aortic or extramesenteric node dissection) show that these techniques increase the LN count, while any beneficial effect on the risk of local recurrence or disease-free survival is at present uncertain due to the lack of controlled trials. Ongoing randomized trials comparing extensive vs. standard surgery for CC will generate important answers.

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“…However, laparotomy cases were excluded, and the effects of high or low ligation of the IMA on long-term oncologic outcomes were not reported. In Fujii's study [12], laparotomy cases were included, and the results showed that the IMA ligation level was unrelated to anastomotic leakage. Further, there was no signi cant difference observed in the long-term outcomes in patients with or without LCA preservation.…”

mentioning

confidence: 99%

Long-term oncological outcomes of low anterior resection for rectal cancer with and without preservation of the left colic artery: A retrospective cohort study.

Luo

et al. 2020

Preprint

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BackgroundThere is uncertainty in the literature about the best surgical approach for low anterior resection of rectal cancer to deal with the inferior mesenteric artery (IMA), that is to preserve left colic artery or not. We analyzed the effect of preserving the left colic artery (LCA) on long-term oncological outcomes. MethodsWe retrospectively collected clinicopathological and follow-up details of patients who underwent low anterior resection for rectal cancer in the General Surgery Department of Guangdong Provincial People's Hospital, from January 2014 to December 2015. Cases were divided into low ligation (LL) or high ligation (HL) of the IMA The 5-year overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups. ResultsAltogether, there were 221 cases in the LL group (LCA preserved) and 295 cases in the HL group (LCA not preserved). Postoperative 30-day mortality was 0.9% in the LL group and 1.4% in the HL group. Early complications occurred in 41.2% patients in the LL group and 38.3% in the HL group. Anastomotic leakage occurred in 8.6% of patients in the LL group and in 13.2% in the HL group. The numbers of lymph nodes harvested were 18.8 ± 9.6 in the LL group and 17.0 ± 6.6 in the HL group. The median follow-up periods were 51.4 (7–61) months in the LL group and 51.2 (8–61) months in the HL group. During follow-up, the percentages of patients who died, had local recurrence, or had metastases were 39.8%, 7.7%, and 38.5%, respectively, in the LL group and 39%, 8.5%, and 40%, respectively, in the HL group; these differences were not significant (all P ＞ 0.05). The 5-year OS and DFS were 69.6% and 59.6% in the LL group, respectively, and 60.1% and 56.2% in the HL group, respectively; these differences were not significant (all P ＞ 0.05). After stratification by tumor-node-metastasis stage, the difference between the 5-year OS and DFS for stages I, II, and III cancer were not significant (all P ＞ 0.05). ConclusionsThe long-term oncological outcomes of low anterior resection for rectal cancer with preservation of the LCA are comparable with those of ligation at the IMA origin.

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Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (High tie vs. low tie) study

Abstract: The IMA ligation level was unrelated to anastomotic leakage. No significant difference was detected in long-term results between HT and LT.

Cited by 58 publications

References 32 publications

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

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

Biology-Based Surgery: The Extent of Lymphadenectomy in Cancer of the Colon

Long-term oncological outcomes of low anterior resection for rectal cancer with and without preservation of the left colic artery: A retrospective cohort study.

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