Preservation of left colon artery or not in laparoscopic anterior resection of rectal cancer: A Meta-analysis

Abstract

Objective To systematically review the safety and effectiveness of preserving the left colic artery (LCA) in laparoscopic anterior resection of rectal cancer. Methods A literature search was conducted on the databases which included the PubMed, EMBase, Cochrane library, Sinomed, Wanfang, VIP, and CNKI. The retrieval time was from inception to February 2018. Meta analysis was performed using Revman 5.3 software. Results A total of 1 863 patients were included in 12 articles. Among them, 937 cases were high tie group (preservation of LCA), and 926 cases in the low tie group (without preservation of LCA). Compared with group HT, the anastomotic leakage (OR=2.77; 95%CI: 1.73, 4.42; P<0.001), free splenic flexure (OR=13.00; 95%CI: 3.90, 43.37; P<0.001) and prophylactic ileostomy (OR=2.29; 95%CI: 1.55, 3.38; P<0.001) in group LT were all decreased. There were no significant differences in the number of lymph nodes removed around the root of inferior mesenteric artery (WMD=0.03; 95%CI: -0.14, -0.21; P=0.69) , the total of lymph nodes dissection (WMD=0.40; 95%CI: 0, 0.80; P=0.05) and the rate of the recurrence and metastasis (OR=0.96; 95%CI: 0.68, 1.35; P=0.79). The operation time of group HT was shorter than that of group LT (WMD=-7.06; 95%CI: -10.75, -3.36; P<0.001). Conclusion Low ligation of inferior mesenteric artery and preservation of LCA has benefit in recent therapeutic effects such as anastomotic leakage, but there was no benefit in relapse or metastasis. Key words: Rectal neoplasms; High tie; Low tie; Mesenteric artery, inferior; Left colic artery; Meta-analysis