Preserving left colic artery in anterior resection reduce the incidence of anastomotic leakage in rectal cancer patients: A prospective cohort study

Abstract Background Whether or not to preserving left colic artery(LCA) in anterior resection for rectal cancer and its effect on anastomotic leakage are remains controversial. The aim of this study was to investigate the clinical outcomes of preserving the LCA during anterior resection for rectal cancer. We further explored branching types of the inferior mesenteric artery(IMA) based on the three-dimensional computed tomography reconstruction images. Methods Between January 2017 and October 2019, patients who underwent anterior resection for rectal cancer were allocated to preservation LCA or non-preservation LCA. Evaluation parameters including intraoperative conditions, pathological outcomes, postoperative complications, and short-term results. Furthermore, preoperative three-dimensional computer tomography reconstruction were performed to assess types of IMA. Results 160 patients with rectal cancer were enrolled in this study, 56 were arranged to preservation LCA and 104 to non-preservation LCA. The incidence of anastomotic leakage and overall early complications were significantly(P<0.05) decreased in the preservation LCA group. The reoperation rate of the preservation LCA group (1.8%) was lower than that of the non-preservation LCA group (10.6%), but the difference was not statistically significant (P>0.05). The two groups did not significantly(P>0.05) differ in blood loss, intraoperative complications, total number of harvested lymph nodes, and number of positive lymph nodes. The three-dimensional computer tomography reconstruction images of 108 patients with rectal cancer were evaluated, the IMA was divided into four types, of which 53(49.1%) were type I, 24 (22.2%) were type II, 18 (16.7%) were type III, and 13 (12%) were type IV. Conclusions The preservation of LCA in anterior resection for rectal cancer could help reducing the incidence of anastomotic leakage, overall early complications and without increasing other known risks. The three-dimensional computer tomography reconstruction technique was useful for evaluating the IMA types to facilitate make intraoperative surgical decisions and preservation of LCA during rectal cancer surgery.

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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.

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Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

10.21203/rs.3.rs-54678/v1 ◽

2020 ◽

Author(s):

Yuwen Luo ◽

Rongjiang Li ◽

Deqing Wu ◽

Jun Zeng ◽

Junjiang Wang ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Oncologic Outcomes ◽

Colic Artery ◽

Left Colic Artery ◽

Laparoscopic Low Anterior Resection ◽

The Difference

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.

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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.

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