Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2020; 12(6): 632-641
Published online Jun 15, 2020. doi: 10.4251/wjgo.v12.i6.632
Low ligation has a lower anastomotic leakage rate after rectal cancer surgery
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Fu-Qiang Zhao, Fang-Ze Wei, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Jun Yu, Qian Liu
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Fu-Qiang Zhao, Fang-Ze Wei, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
Jun Yu, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
Author contributions: Chen JN, Zhao FQ, and Wang ZJ designed the research; Mei SW, Shen HY, Wei FZ and Li J collected the data; Pei W, Wang Z, Liu Z analyzed the data; Chen JN drafted the article; Liu Q and Yu J revised the paper.
Supported by the Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006; and China Scholarship Council, No. CSC201906210471.
Institutional review board statement: Our investigation received approval from the ethics committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All patients signed informed consent forms.
Conflict-of-interest statement: The authors declare there is no conflict of interest in regard to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have carefully read the STROBE statement checklist of items and prepared the manuscript based on the requirements of the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Received: January 11, 2020
Peer-review started: January 11, 2020
First decision: April 7, 2020
Revised: May 13, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 15, 2020
Processing time: 155 Days and 10.3 Hours
ARTICLE HIGHLIGHTS
Research background

Rectal cancer is a common malignancy of the digestive tract, and laparoscopic rectal cancer surgery has rapidly replaced open surgery. The ligation level of the inferior mesenteric artery during the surgery remains a controversial topic.

Research motivation

There is a lack of consensus concerning the management of the left colic artery in the low anterior resection of rectal cancer. Whether ligation level is associated with anastomotic leakage (AL) is still under debate. There are limited data regarding surgical outcomes of total mesorectal excision with left colic artery preservation.

Research objectives

The main aim of this study was to investigate whether different ligation levels affect perioperative outcomes.

Research methods

We performed a retrospective cohort study and enrolled rectal cancer patients treated with different ligation levels. Information regarding the clinicopathological features and clinical outcomes were obtained and analyzed. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for AL in rectal cancer patients.

Research results

Preservation of the left colic artery was associated with a significantly lower AL rate. Tumor located below the peritoneal reflection and age (≥ 65 years) were also risk factors for AL.

Research conclusions

Our study showed a lower AL and diverting stoma rate in the left colic artery preservation group. Low ligation should be the preferred method for rectal cancer patients.

Research perspectives

Larger prospective multicenter clinal studies need to be performed so that standard management regarding the left colic artery in rectal cancer can be established.