Evaluation of the clinical efficacy of preserving the left colic artery in laparoscopic resection for rectal cancer: A meta‑analysis

Fan,Dongwei; Zhang,Chensong; Li,Xuanhe; Yao,Changyang; Yao,Tingjing

doi:10.3892/mco.2018.1714

Evaluation of the clinical efficacy of preserving the left colic artery in laparoscopic resection for rectal cancer: A meta‑analysis

Authors:
- Dongwei Fan
- Chensong Zhang
- Xuanhe Li
- Changyang Yao
- Tingjing Yao
View Affiliations

Affiliations: Department of Surgical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
Published online on: September 7, 2018 https://doi.org/10.3892/mco.2018.1714
Pages: 553-560

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the present meta-analysis compared left colic artery (LCA) preservation with non-preservation in laparoscopic resection of rectal cancer in terms of feasibility, efficacy and safety. The PubMed, Ovid, Embase, Web of Science, CBM, CNKI, VIP and WanFang Data databases were searched prior to June 2017 for studies comparing LCA preservation and non‑preservation in laparoscopic resection for rectal cancer. Two researchers screened the literature independently, extracted the data and evaluated the risk of bias. The study was performed using RevMan 5.3 software for meta‑analysis. A total of 10 studies comparing LCA preservation and non‑preservation in laparoscopic resection for rectal cancer were selected for this meta‑analysis, with a combined study population of 1,471 patients. The results of the meta‑analysis demonstrated that, when comparing LCA preservation with non‑preservation in laparoscopic resection for rectal cancer, there were significant differences between the two groups in terms of operative time (P<0.01), estimated blood loss (P<0.01), percentage of neostomy (P<0.01), the number of retrieved lymph nodes (P<0.01), time to first postoperative exhaust (P<0.01) and amount of anastomotic leakage (P<0.01). However, there were no significant differences in postoperative hospital stay (P=0.28), incidence of recurrence (P=0.73) and incidence of metastasis (P=0.52). Therefore, compared with LCA non‑preservation, patients in whom the LCA was preserved during laparoscopic resection for rectal cancer had a better prognosis. However, there was no difference in recurrence or metastasis between the two groups. Although the operative time and estimated blood loss were increased with LCA preservation, these may be reduced with improving proficiency of the operating surgeons. The conclusions of the present study require verification by larger samples and high‑quality randomized controlled trials.

View Figures

View References

1	Zhang H, Yuan W, Zhou Q, Gu X and Wang F: Efficacy comparison of robotic and laparoscopic radical surgery in the treatment of middle-low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 20:540–544. 2017.(In Chinese). PubMed/NCBI
2	Bjørn MX and Perdawood SK: Surgical treatment of mid- and low rectal cancer. Ugeskr Laeger. 179:pii: V11160801. 2017.(In Danish).
3	Kube R, Ptok H, Steinert R, Sahm M, Schmidt U, Gastinger I and Lippert H: Clinical value of laparoscopic surgery for colon cancer. Chirurg. 79:1145–1150. 2008.(In German). View Article : Google Scholar : PubMed/NCBI
4	Mabardy A, Lee L, Valpato AP and Atallah S: Transanal total mesorectal excision with intersphincteric resection and use of fluorescent angiography and a lighted urethral stent for distal rectal cancer. Tech Coloproctol. 21:581–582. 2017. View Article : Google Scholar : PubMed/NCBI
5	Guo Y, Wang D, He L, Zhang Y, Zhao S, Zhang L, Sun X and Suo J: Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: A clinical trial. ANZ J Surg. 87:576–581. 2015. View Article : Google Scholar : PubMed/NCBI
6	Niu JW, Ning W, Wang WY, Pei DP, Meng FQ, Liu ZZ and Cai DG: Clinical effect of preservation of the left colonic artery in laparoscopic anterior resection for rectal cancer. Zhonghua Yi Xue Za Zhi. 96:3582–3585. 2016.(In Chinese). PubMed/NCBI
7	Zhang L, Zang L, Ma J, Dong F, He Z and Zheng M: Preservation of left colic artery in laparoscopic radical operation for rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 19:886–891. 2016.(In Chinese). PubMed/NCBI
8	Rutegård M, Hassmén N, Hemmingsson O, Haapamäki MM, Matthiessen P and Rutegård J: Anterior resection for rectal cancer and visceral blood flow: An explorative study. Scand J Surg. 105:78–83. 2016. View Article : Google Scholar : PubMed/NCBI
9	Yasuda K, Kawai K, Ishihara S, Murono K, Otani K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, et al: Level of arterial ligation in sigmoid colon and rectal cancer surgery. World J Surg Onco. 14:992016. View Article : Google Scholar
10	Yamamoto M, Okuda J, Tanaka K, Ishii M, Hamamoto H and Uchiyama K: Oncological impact of laparoscopic lymphadenectomy with preservation of the left colic artery for advanced sigmoid and rectosigmoid colon cancer. Dig Surg. 31:452–458. 2014. View Article : Google Scholar : PubMed/NCBI
11	Matsuda K, Hotta T, Takifuji K, Yokoyama S, Oku Y, Watanabe T, Mitani Y, Ieda J, Mizumoto Y and Yamaue H: Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg. 102:501–508. 2015. View Article : Google Scholar : PubMed/NCBI
12	Tanaka J, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Kawai K, Kazama S, Nozawa H, Yamaguchi H, Ishihara S, et al: Analysis of anastomotic leakage after rectal surgery: A case-control study. Ann Med Surg (Lond). 4:183–186. 2015. View Article : Google Scholar : PubMed/NCBI
13	Liu F and Zhang LA: A clinical comparative study on reservation of left colic artery in laparoscopic resection of rectal cancer. J Clin Experimental Med. 16:1013–1016. 2017.
14	Shen J, Li MZ, Du YF, Qu H and Zhang Y: A comparative study of laparoscopic anterior resection of rectal carcinoma with and without preservation of the left colonic artery. Chin J Min Inv Surg. 14:22–24. 2014.(In Chinese).
15	Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, Sugihara K and Watanabe M: Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg. 37:2935–2943. 2013. View Article : Google Scholar : PubMed/NCBI
16	Nonaka S, Saito Y, Takisawa H, Kim Y, Kikuchi T and Oda I: Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation. Surg Endosc. 24:1638–1645. 2010. View Article : Google Scholar : PubMed/NCBI
17	Wolf FM: Meta-Analysis: Quantitative methods for research synthesis by Fredric M. 1st edition. Sage Publications Beverly Hills; CA: pp. 77–92. 1986
18	Gu H, Wang Y and Li W: The application of cochrane risk of bias tools in meta-analysis of RCT. Chin Circ J. 29:147–148. 2014.
19	Murray AC, Chiuzan C and Kiran RP: Risk of anastomotic leak after laparoscopic versus open colectomy. Surg Endosc. 30:5275–5282. 2016. View Article : Google Scholar : PubMed/NCBI
20	Leake PA, Plummer JM, Rhoden A, Frankson MA, Gordon-Strachan G, Powell LP and Roberts PO: Colorectal anastomotic leakage at the university hospital of the west indies: An analysis of risk factors. West Indian Med J. 62:711–715. 2013.PubMed/NCBI
21	Tocchi A, Mazzoni G, Fornasari V, Miccini M, Daddi G and Tagliacozzo S: Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease. Am J Surg. 182:162–167. 2001. View Article : Google Scholar : PubMed/NCBI
22	Thomas MS and Margolin DA: Management of colorectal anastomotic leak. Clin Colon Rectal Surg. 29:138–144. 2016. View Article : Google Scholar : PubMed/NCBI
23	Sekimoto M, Takemasa I, Mizushima T, Ikeda M, Yamamoto H, Doki Y and Mori M: Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery. Surg Endosc. 25:861–866. 2011. View Article : Google Scholar : PubMed/NCBI
24	Dworkin MJ and Allen-Mersh TG: Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg. 183:357–360. 1996.PubMed/NCBI
25	Seike K, Koda K, Saito N, Oda K, Kosugi C, Shimizu K and Miyazaki M: Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis. 22:689–697. 2007. View Article : Google Scholar : PubMed/NCBI
26	Komen N, Slieker J, de Kort P, de Wilt JH, van der Harst E, Coene PP, Gosselink MP, Tetteroo G, de Graaf E, van Beek T, et al: High tie versus low tie in rectal surgery: Comparison of anastomotic perfusion. Int J Colorectal Dis. 26:1075–1083. 2011. View Article : Google Scholar : PubMed/NCBI