Flush aortic tieversus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma

Abstract 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.

Download Full-text

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

10.21203/rs.3.rs-54678/v2 ◽

2020 ◽

Author(s):

Yuwen Luo ◽

Rongjiang Li ◽

Deqing Wu ◽

Jun Zeng ◽

Junjiang Wang ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Disease Free Survival ◽

Colic Artery ◽

Left Colic Artery ◽

Oncological Outcomes ◽

Tumor Node Metastasis Stage

Abstract 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.

Download Full-text

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

BMC Cancer ◽

10.1186/s12885-021-07848-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuwen Luo ◽

Rongjiang Li ◽

Deqing Wu ◽

Jun Zeng ◽

Junjiang Wang ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Colic Artery ◽

Early Complications ◽

Left Colic Artery ◽

Oncological Outcomes

Abstract Background There is uncertainty in the literature about preserving the left colic artery (LCA) during low anterior resection for rectal cancer. We analyzed the effect of preserving the LCA on long-term oncological outcomes. Methods We 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), LCA preserved, or high ligation (HL), LCA not preserved, of the inferior mesenteric artery. The 5-year overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups. Results Altogether, there were 221 and 295 cases in the LL group and HL groups, respectively. Operating time in the LL group was significantly longer than in the HL group (224.7 vs. 211.7 min, p = 0.039). Postoperative 30-day mortality, early complications including anastomotic leakage showed no significant differences between the LL and HL groups (postoperative 30-day mortality, 0.9% LL, 1.4% HL, p = 0.884; early complications, 41.2% LL, 38.3% HL, p = 0.509; anastomotic leakage 8.6% LL, 13.2% HL, p = 0.100). 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 69.1 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). Conclusions The long-term oncological outcomes of LL group are comparable with HL group. LL cannot be supported due to the absence of lower complication rates and the longer operating times.

Download Full-text

The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

BMC Geriatrics ◽

10.1186/s12877-020-02001-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amal Rhemouga ◽

Stefan Buettner ◽

Wolf O. Bechstein ◽

Guido Woeste ◽

Teresa Schreckenbach

Keyword(s):

Rectal Cancer ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Older Patients ◽

Retrospective Cohort ◽

Loop Ileostomy ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

Download Full-text

A Successful Case of Conservative Therapy with Estriol and Chloramphenicol for Rectovaginal Fistula after Low Anterior Resection for Rectal Carcinoma

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.70.424 ◽

2017 ◽

Vol 70 (6) ◽

pp. 424-427

Author(s):

Shinichi Yoshioka ◽

Mutsumi Fukunaga ◽

Masaki Tsujie ◽

Shigeyuki Ueshima ◽

Riichiro Nezu

Keyword(s):

Rectal Carcinoma ◽

Anterior Resection ◽

Rectovaginal Fistula ◽

Low Anterior Resection ◽

Conservative Therapy ◽

Successful Case

Download Full-text

Heterotopic Ossification in Rectal Carcinoma: Report of a Case and Review of the Literature

Case Reports in Oncology ◽

10.1159/000452297 ◽

2016 ◽

Vol 9 (3) ◽

pp. 698-704 ◽

Cited By ~ 2

Author(s):

Jiro Shimazaki ◽

Akira Takemura ◽

Kiyotaka Nishida ◽

Hideki Kajiyama ◽

Mitsugi Shimoda ◽

...

Keyword(s):

Heterotopic Ossification ◽

Histological Examination ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Virtual Colonoscopy ◽

Rectal Wall ◽

Medical Center ◽

Uneventful Recovery ◽

Spindle Cells

Heterotopic ossification in colorectal carcinoma is extremely rare. This report presents the case of a 57-year-old male who had undergone a low anterior resection following a diagnosis of rectal carcinoma. Histological examination showed heterotopic ossification in the tumor. The patient was referred to Ibaraki Medical Center, Tokyo Medical University, with a diagnosis of rectal carcinoma by a local physician. Abdominal computed tomography revealed thickening of the rectal wall with calcified deposits, and virtual colonoscopy showed stenosis with a mass in the rectum. The patient underwent a low anterior resection and diverting ileostomy in May 2014. Histological examination of the excised tumor showed moderately differentiated adenocarcinoma and an infiltration of spindle cells with numerous foci of osteoid and ossification, with osteoblastic rimming in the stroma. Immunohistochemical analysis of these spindle cells and osteoblasts revealed negative staining for AE1/AE3, suggesting a reactive change. There was metastasis in 1 of the 12 lymph nodes, and the tumor was diagnosed as stage IIIB (T4a, N1a, M0) rectal carcinoma. The patient had an uneventful recovery and was followed up at our outpatient clinic. In conclusion, the malignant potential of heterotopic ossification in rectal carcinoma has not been determined. However, heterotopic ossification is induced by tumor progression in a microenvironment, suggesting a high tumor malignity. The patient should be carefully monitored after surgery in terms of improved patient outcome.

Download Full-text