Effect of left colic artery-preserving lymph node dissection at the root of the inferior mesenteric artery

doi:10.3877/cma.j.issn.1674-0785.2024.07.006

Abstract

Abstract:

Objective

To investigate the effect of left colic artery （LCA）-preserving lymph node dissection at the root of the inferior mesenteric artery （IMA） on the efficacy of laparoscopic radical resection of rectal cancer.

Methods

Clinical data of patients undergoing laparoscopic radical resection for rectal cancer at the Department of General Surgery of Beijing Fengtai Hospital from February 2017 to February 2019 were retrospectively analyzed. According to the location where the IMA was ligated， 23 cases were included in a high ligation group （Group H， IMA root ligation） and 74 were included in a low ligation group（group L， LCA preserved）. Operation parameters （operation time， intraoperative blood loss， number of lymph nodes dissected， number of metastatic lymph nodes， postoperative hospital stay， and time to postoperative intestinal function recovery）， postoperative complications， and postoperative 2-year recurrence rate and 5-year survival rate were compared between the two groups.

Results

There was no statistical difference between the two groups in preoperative TNM stage. The time to postoperative intestinal function recovery was shorter in group L than in group H （P＜0.05）， but there was no statistical difference in the rest operation parameters. The incidence of postoperative anastomotic leakage and urinary dysfunction in group L was lower than that of group H （P＜0.05）. The postoperative 2-year recurrence rate and 5-year survival rate were not statistically different between the two groups.

Conclusion

LCA-preserving lymph node dissection at the root of the IMA can not only shorten the time to postoperative intestinal function recovery but also reduce the incidence of postoperative anastomotic leakage and urinary dysfunction without affecting the curative effect of laparoscopic radical resection for rectal cancer .

Key words: Rectal cancer, Inferior mesenteric artery, Left colic artery

Fucheng Liu, Xin Zhao, Haipeng Qiao, Xiaofeng Liu, Chong Zhang, Zongming Zhang. Effect of left colic artery-preserving lymph node dissection at the root of the inferior mesenteric artery[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 647-653.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2024.07.006

https://zhlcyszz.cma-cmc.com.cn/EN/Y2024/V18/I07/647

Figures/Tables 9

项目	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
性别［例（%）］			0.913
男性	14（61.0）	45（61.0）
女性	9（39.0）	29（39.0）
年龄（岁， $\bar{x}$ ±s）	58.3±10.1	60.4±9.4	0.701
肿瘤部位［例（%）］			0.196
直乙交界处	10（44.0）	27（36.0）
上段直肠	7（30.0）	24（32.0）
下段直肠	6（26.0）	23（32.0）
术前肿瘤TNM分期［例（%）］			0.227
I	5（22.0）	17（23.0）
II	8（34.0）	27（36.0）
III	10（44.0）	30（41.0）

项目	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
性别［例（%）］			0.913
男性	14（61.0）	45（61.0）
女性	9（39.0）	29（39.0）
年龄（岁， $\bar{x}$ ±s）	58.3±10.1	60.4±9.4	0.701
肿瘤部位［例（%）］			0.196
直乙交界处	10（44.0）	27（36.0）
上段直肠	7（30.0）	24（32.0）
下段直肠	6（26.0）	23（32.0）
术前肿瘤TNM分期［例（%）］			0.227
I	5（22.0）	17（23.0）
II	8（34.0）	27（36.0）
III	10（44.0）	30（41.0）

分组	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
手术时间（min， $\bar{x}$ ±s）	210±34.2	232±28.3	0.570
术中出血量（ml， $\bar{x}$ ±s）	145±30.3	187±50.3	0.2185
术后住院时间（d， $\bar{x}$ ±s）	10.3±1.5	9.6±1.8	0.256
淋巴结转移例数	10	30	0.904
淋巴结清扫数量	17.2	15.6	0.184
术后肠功能恢复时间（d， $\bar{x}$ ±s）	5.0±1.8	3.0±1.2	0.039

分组	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
手术时间（min， $\bar{x}$ ±s）	210±34.2	232±28.3	0.570
术中出血量（ml， $\bar{x}$ ±s）	145±30.3	187±50.3	0.2185
术后住院时间（d， $\bar{x}$ ±s）	10.3±1.5	9.6±1.8	0.256
淋巴结转移例数	10	30	0.904
淋巴结清扫数量	17.2	15.6	0.184
术后肠功能恢复时间（d， $\bar{x}$ ±s）	5.0±1.8	3.0±1.2	0.039

分组	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
并发症发生数	6（26.0）	15（20.0）	0.471
切口感染	2（9.0）	8（11.0）	0.305
应激性溃疡	1（4.0）	3（4.0）	0.298
吻合口漏	2（9.0）	3（4.0）	0.043
排尿功能障碍	1（4.0）	1（1.0）	0.028

复发部位/分组	高位结扎组（H组，n=23）	低位结扎组（L组，n=74）	P值
总体复发率（%）	5（22.0）	16（22.0）	0.581
肝	2	5
肺	2	4
淋巴结	1	3
局部复发（肠道）	0	2

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