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:
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.
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
Research background

Sigmoid and rectal tumors are the most common intestinal tumors, accounting for 80% of all colorectal cancers. Surgery is still the preferred and primary treatment of intestinal tumors, and the anatomical basis is total mesangectomy. However, a critical point is that the location of ligation of the inferior mesenteric artery (IMA) is still under debate.

Research motivation

At present, there are two mainstream methods used in laparoscopic colorectal cancer surgery. One is high ligation (H-L), that is, ligation at the beginning of the IMA, and the other is low ligation (L-L) at the distal end of the left colic artery. The two methods have their own advantages. Therefore, we systematically compared the two methods to provide a reference basis for surgeons to choose.

Research objectives

To investigate the prognostic significance of the ligation site of the IMA in colorectal cancer surgery.

Research methods

We retrospectively analyzed the data of 194 patients undergoing radical R0 resection at Beijing Friendship Hospital between February 2014 to February 2016. Operative time, blood loss, positive lymph nodes and the number of dissected lymph nodes, postoperative complications and recovery, recurrence rate, and 5-year survival rate were compared between the H-L group and L-L group.

Research 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%) in the H-L group and 60 patients (41%) in the L-L group with positive lymph nodes, with no statistical differences between the groups. Complications occurred in 12 cases (26%) in the H-L group and 26 cases (18%) in the L-L group, with no significant difference in the incidence between the groups. The incidences of postoperative anastomotic complications and functional urinary complications were significantly lower in the L-L group. The incidence of other complications was similar between the two groups. The 5-year survival rates in the 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.

Research conclusions

Complete mesenteric resection and IMA root lymph node dissection while preserving the LCA is a more reliable and safe surgical approach during laparoscopic resection for colorectal cancer.

Research perspectives

Our study demonstrated that LCA preservation is highly feasible at its origin in most cases. A preoperative computed tomography scan could predict the feasibility of the determined origin of the LCA (spread out or not) and the route (near or far away from the inferior mesenteric vein) of the LCA. In the future, multicenter prospective studies with a larger sample size are required to verify our results.