Short- and long-term outcomes of rectal cancer patients with high or improved low ligation of the inferior mesenteric artery

Chenghai Zhang,Jiadi Xing,Zhendan Yao,Ming Cui,Nan Zhang,Maoxing Liu,Kai Xu,Xiangqian Su,Fei Tan,Hong Yang,Lei Chen

doi:10.1038/s41598-020-72303-0

Chenghai Zhang, Jiadi Xing + Show 9 more

Open Access

https://doi.org/10.1038/s41598-020-72303-0

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Abstract

The ligation site of the inferior mesenteric artery (IMA) during laparoscopic radical resection for rectal cancer has been controversial. Consecutive patients (n = 205) with rectal cancer who underwent laparoscopic-assisted low anterior resection from January 2009 to December 2015 were retrospectively analyzed. The patients were divided into high ligation (n = 126) and improved low ligation groups (n = 79). A total of 205 rectal cancer patients underwent laparoscopic assisted anterior resection: 126 patients in the high ligation group and 79 patients in the improved low ligation group. The improved low ligation group was better than the high ligation group in terms of postoperative flatus time and postoperative defecation time. There were no differences between the groups in terms of blood loss, operation time, total number of lymph nodes, anastomotic leakage, postoperative time to first liquid diet and postoperative hospital stay. There were also no differences in 5-year overall survival (OS). Compared to high ligation, the improved low ligation ensures the extent of lymph node dissection, and promotes the early recovery of postoperative gastrointestinal function, but does not increase the operation time, bleeding risk, or anastomotic leakage. A ligation site of the IMA in laparoscopic rectal cancer surgery may not influence oncological outcomes.

Highlights

The ligation site of the inferior mesenteric artery (IMA) during laparoscopic radical resection for rectal cancer has been controversial
In laparoscopic rectal cancer surgery, the ligation site of the IMA can be divided into a high ligation site, where the IMA is ligated at its origin from the aorta and the traditional low ligation site, which is below the branch of the left colon artery (LCA)
Preoperative chemotherapy was performed in 19 patients and 10 patients in the high ligation group and improved low ligation group, respectively

Summary

Introduction

The ligation site of the inferior mesenteric artery (IMA) during laparoscopic radical resection for rectal cancer has been controversial. In laparoscopic rectal cancer surgery, the ligation site of the IMA can be divided into a high ligation site , where the IMA is ligated at its origin from the aorta and the traditional low ligation site, which is below the branch of the left colon artery (LCA). These two ligation methods have their own advantages and disadvantages. Traditional low ligation may reduce anastomotic leakage, due to increased blood flow to the proximal end of the anastomosis[3,10] This type of ligation may affect long-term survival because of the absence of upward lymph node dissection. Category Age (years)* Sex Male Female Body mass index (kg/m2) ≥ 25 < 25 Tumor size (cm)* Tumor location Lower Middle Upper T stage T1 T2 T3 T4 TNM stage I II III Preoperative CRTYes No Prophylactic ileostomy Yes No

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