Feasibility evaluation on preservation of left colonic artery in dealing with inferior mesenteric artery in laparoscopic anterior resection of rectal carcinoma

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Objective To explore the feasibility and value of preservation of left colonic artery (LCA) in dealing with inferior mesenteric artery (IMA) in laparoscopic anterior resection of rectal carcinoma.Methods The clinical data of 72 cases of laparoscopic anterior resection of rectal carcinoma from April 2010 to October 2013 were retrospectively analyzed including 32 cases with preservation of LCA (observation group) and 40 cases without preservation of LCA (control group).The blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA and prognosis were compared between two groups.Results There was no significant difference in the blood loss,operative time,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of IMA,the rate of lymph node metastasis around the root of IMA between two groups (P ＞ 0.05).No case in observation group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 3 cases in control group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine (P =0.046),and 4 cases underwent terminal ileum stoma following anastomosis (P =0.042).No anastomotic leakage occurred in observation group,while 2 cases of anastomotic leakage occurred in control group(P =0.090).After followed up for 6-48 months,no significant difference was found in local recurrence and liver metastasis in two groups (P ＞ 0.05).Conclusion Laparoscopic anterior resection of rectal carcinoma with preservation of LCA in dealing with IMA can effectively retain the blood supply of proximal intestine. Key words: Rectal neoplasms; Mesenteric artery,inferior; Anastomotic leak; Left colic artery