Clinical Effect of Preservation or Nonpreservation of Left Colic Artery in Total Mesorectal Excision under Laparoscopy: A Meta-analysis

Jiefeng Liu,Yujing Gong,Xinyu Zeng,Miao He,Yiping Liu

doi:10.1155/2020/1958573

Abstract

Background and Aims To investigate the clinical effect of preservation or nonpreservation of the left colic artery (LCA) in total mesorectal excision (TME) under laparoscopy. Methods The words, like “rectal cancer,” “left colonic artery,” and “laparoscopy,” were used as the retrieval terms, and the keyword retrieval method was adopted. The retrieval period was set as from January 1, 2013, to June 1, 2018. We searched databases including PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) to collect randomized and controlled trials which compared the effect of preservation or nonpreservation of the LCA in TME under laparoscopy. Two researchers independently carried out literature screening, data extraction, and literature quality evaluation; Review Manager 5.3 was used for the meta-analysis. Results Seven studies including 1467 cases were identified for the meta-analysis. As showed by the meta-analysis, compared with the LCA nonpreservation group, the LCA preservation group had significantly reduced incidence of anastomotic leakage (OR = 0.44, CI = [0.30, 0.65], P < 0.0001) and postoperative urinary and sexual dysfunction (OR = 0.26, CI = [0.09, 0.78], P = 0.02) and significantly shorter time for intestinal function recovery (WMD = −0.26, CI = [−0.41, −0.11], P = 0.0008). There were no significant differences between the two groups in the duration of surgery, blood loss, number of dissected lymph nodes, or postoperative hospital stay. Conclusions From the results, the LCA preservation group seems to achieve comparable success with acceptable safety outcomes. Therefore, this surgical method can be recommended in the clinical practice.

Highlights

Colorectal cancer is the third most common malignancy that causes significant morbidity and mortality in the world
More than 1.3 million people are diagnosed with colorectal cancer each year, and more than 600,000 patients die from colorectal cancer or related complications [1, 2]
Professor Moynihan proposed the concept of high ligation, which was to ligature the inferior mesenteric artery by ligation at the distal end of the inferior mesenteric artery [3]

Summary

Introduction

Colorectal cancer is the third most common malignancy that causes significant morbidity and mortality in the world. With the development of the TME concept and the development of laparoscopic surgery, the surgical treatment of rectal cancer has undergone tremendous changes. In laparoscopic rectal cancer TME, the treatment of IMA and its branches mainly includes “high ligation and low ligation.”. The branch of the inferior mesenteric artery (IMA) should be clearly dissected during the surgery, but there is a controversy over whether the LCA should be preserved [6]. Foreign researches in this aspect basically focused on in-hospital cases. The LCA preservation group seems to achieve comparable success with acceptable safety outcomes This surgical method can be recommended in the clinical practice

Results

Discussion

Conclusion