Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 871-884
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.871
Genitourinary function and defecation after colorectal cancer surgery with low- and high-ligation of the inferior mesenteric artery: A meta-analysis
Xiao Bai, Chun-Dong Zhang, Jun-Peng Pei, Dong-Qiu Dai
Xiao Bai, Chun-Dong Zhang, Jun-Peng Pei, Dong-Qiu Dai, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
Chun-Dong Zhang, Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
Dong-Qiu Dai, Cancer Center, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province , China
Author contributions: Bai X and Dai DQ contributed to the study design; Bai X, Pei JP, and Zhang CD carried out the data collection and selection; Bai X carried out the data analysis and writing of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Dong-Qiu Dai, MD, PhD, Professor, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, No. 4 Chongshan East Road, Shenyang 110032, Liaoning Province, China. daidq63@163.com
Received: April 22, 2021
Peer-review started: April 22, 2021
First decision: June 4, 2021
Revised: June 12, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 27, 2021
Abstract
BACKGROUND

The effect of low ligation (LL) vs high ligation (HL) of the inferior mesenteric artery (IMA) on functional outcomes during sigmoid colon and rectal cancer surgery, including urinary, sexual, and bowel function, is still controversial.

AIM

To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer (CRC) surgery.

METHODS

EMBASE, PubMed, Web of Science, and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL. A total of 14 articles, including 4750 patients, were analyzed using Review Manager 5.3 software. Dichotomous results are expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and continuous outcomes are expressed as weighted mean differences (WMDs) with 95%CIs.

RESULTS

LL resulted in a significantly lower incidence of nocturnal bowel movement (OR = 0.73, 95%CI: 0.55 to 0.97, P = 0.03) and anastomotic stenosis (OR = 0.31, 95%CI: 0.16 to 0.62, P = 0.0009) compared with HL. The risk of postoperative urinary dysfunction, however, did not differ significantly between the two techniques. The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage, postoperative complications, total lymph nodes harvested, blood loss, operation time, tumor recurrence, mortality, 5-year overall survival rate, or 5-year disease-free survival rate.

CONCLUSION

Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries, we suggest that LL be preferred over HL.

Keywords: Low ligation, High ligation, Colorectal cancer, Genitourinary function, Defecatory function, Meta-analysis

Core Tip: It remains unclear whether the benefits of low ligation of the inferior mesenteric artery (IMA) during sigmoid colon and rectal cancer surgeries extend to improved genitourinary and defecatory function. We conducted this meta-analysis to compare low ligation and high ligation of the IMA in terms of functional outcomes, as well as other surgical and long-term survival outcomes.