High ligation versus low ligation of the inferior mesenteric artery and lymph node dissection in laparoscopic rectal cancer surgery

Abstract

Objective To evaluate the surgical complications and root vascular lymph node dissection by high versus low ligation the inferior mesenteric artery (IMA) retaining left colonic artery (LCA) in laparoscopic radical resection of rectal cancer. Methods Clinical data of 357 cases of rectal cancer in our center from Jan 2015 to Dec 2016, were retrospectively analyzed, including 247 cases in high ligation group, 110 cases of low ligation group. Results There was no statistically significant difference in operative time and intraoperative blood loss between the two groups [(105±10)min vs. (113±9)min, t=0.138, P=0.092; (96±21)ml vs. (99±23)ml, t=0.171, P=0.118]. Nor that in the incidence of anastomotic leakage between the two groups (7.3% vs. 4.5%, χ2=0.949, P=0.330). The incidence of low anterior resection syndrome in the two groups was statistically significant (21% vs. 12%, χ2=4.358, P=0.037). There was no significant difference in the total number of lymph nodes dissected between the two groups ([(14.5±4.3) vs. (13.6±3.5), t=1.851, P=0.065]. Conclusion Low ligation of IMA with preservation of LCA in laparoscopic radical operation for rectal cancer provides better blood supply for proximal colon, while achieving same radical clearance of lymph nodes as with high ligation of IMA. Key words: Rectal neoplasms; Mesenteric artery, inferior; Left colic artery