Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 825-833
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.825
Preservation of left colic artery in laparoscopic colorectal operation: The benefit challenge
Fu-Cheng Liu, Jian-Ning Song, Ying-Chi Yang, Zhong-Tao Zhang
Fu-Cheng Liu, Jian-Ning Song, Ying-Chi Yang, Zhong-Tao Zhang, General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Fu-Cheng Liu, General Surgery, Beijing Fengtai Hospital, Beijing 100071, China
Author contributions: Liu FC and Zhang ZT contributed to study conception, data analysis, production of tables, writing the first draft, and revision; Song JN and Yang YC helped to collect the clinical data and followed up with the patients; Liu FC, Song JN, and Zhang ZT were involved in study conception and design, data interpretation, manuscript revision, and discussion; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of Capital Medical University (Approval No. 2021-001-2).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-Tao Zhang, Doctor, Chief Doctor, General Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. zhangzht@ccmu.edu.cn
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 20, 2023
Revised: January 29, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: May 27, 2023
Processing time: 143 Days and 17.4 Hours
Abstract
BACKGROUND

During laparoscopic resection for colorectal cancer, there is controversy regarding whether the left colic artery (LCA) should be preserved at its origin.

AIM

To investigate the prognostic significance of preservation of the LCA in colorectal cancer surgery.

METHODS

Patients were divided into two groups. The high ligation (H-L) technique (refers to ligation performed 1 cm from the beginning of the inferior mesenteric artery) group consisted of 46 patients, and the low ligation (L-L) technique (refers to ligation performed below the initiation of the LCA) group consisted of 148 patients. Operative time, blood loss, lymph nodes with tumor invasion, postoperative complications and recovery time, recurrence rate, and 5-year survival rate were compared between the two groups.

RESULTS

The average number of lymph nodes detected in postoperative pathological specimens was 17.4/person in the H-L group and 15.9/person in the L-L group. There were 20 patients (43%) with positive lymph nodes (lymph node metastasis) in the H-L group and 60 patients (41%) in the L-L group. No statistical differences were found between the groups. Complications occurred in 12 cases (26%) in the H-L group and in 26 cases (18%) in the L-L group. The incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L group. The 5-year survival rates in H-L and L-L groups were 81.7% and 81.6%, respectively, and relapse-free survival rates were 74.3% and 77.1%, respectively. The two groups were similar statistically.

CONCLUSION

Complete mesenteric resection combined with lymph node dissection around the inferior mesenteric artery root while preserving the LCA is a beneficial surgical approach during laparoscopic resection for colorectal cancer.

Keywords: Cancer; Complete mesenteric resection; Inferior mesenteric artery; Urinary complications; Lymph

Core Tip: Colorectal cancer is a common disease. The operative method is related to the prognosis. We studied the correlation between different ligation sites of the inferior mesenteric artery and curative effect. There were 20 patients (43%) in the high ligation group and 60 patients (41%) in the low ligation group with positive lymph nodes. There was no significant difference in survival between the two groups. However, the incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L group. This study confirmed that preservation of the left colic artery should be recommended in the surgery.