Abstract: Objective:To investigate the clinical effects of laparoscopic left colic artery (LCA) preserving total mesorectal excision (TME) for middle-low rectal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 339 patients with middle-low rectal cancer who underwent laparoscopic TME in the First Affiliated Hospital of Nanjing Medical University from July 2016 to July 2017 were collected. There were 216 males and 123 females, aged from 35 to 89 years, with an average age of 62 years. No lymph node enlargement was detected at the root of inferior mesenteric artery as evaluated by preoperative examination. Of the 339 patients, 173 undergoing laparoscopic TME with preservation of LCA and 166 without preservation of LCA were allocated into observation group and control group, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect complications and survival of patients after hospital discharge up to August 2018. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the MannWhitney U test. Count data were represented as absolute number or percentage, and comparison between groups was analyzed using the chisquare test or Fisher exact propability. Comparisons of ordinal data were analyzed by MannWhitney U test.
Results:(1) Surgical situations: 339 patients underwent laparoscopic TME successfully, without conversion to open surgery or death. The operation time, volume of intraoperative blood loss and number of lymph nodes dissected at the root of inferior mesenteric artery were (77±15)minutes, (32±22)mL and 3.5±1.3 in the observation group, (74± 16)minutes, (30±21)mL and 3.6±1.3 in the control group, respectively, showing no statistically significant difference between the two groups (t=1.730, 0.790,-0.378, P>0.05). There were 21 and 37 patients receiving preventive stoma in the observation group and control group, with a statistically significant difference between the two groups (X²=6.154, P<0.05). (2) Postoperative situations: no lymphatic metastasis at the root of inferior mesenteric artery was detected in the observation group or control group. The incidence of anastomotic leakage was 8.55%(13/152) and 16.28%(21/129) of patients without preventive stoma in the observation group and control group, with a statistically significant difference between the two groups (X²=3.917, P<0.05). The overall incidence of anastomotic leakage was 7.51%(13/173) and 12.65%(21/166), with no statistically significant difference between the two groups (X²=2.477, P>0.05). Cases with anastomotic hemorrhage and time to first anal sufflation were 18 and (2.2±0.9)days in the observation group, 10 and (2.4±1.0)days in the control group, respectively, showing no statistically significant difference between the two groups (X²=2.145, t=-1.370, P>0.05). (3) Followup: 339 patients were followed up for 13-22 months, with a median time of 14 months. During the followup, 2 patients had postoperative intestinal obstruction, 19 had tumor recurrence or metastasis, and 4 died in the observation group. In the control group, 1 patient had postoperative intestinal obstruction, 17 had tumor recurrence or metastasis, and 3 died. The other patients in the two groups survived well.
Conclusion:Laparoscopic TME with preservation of LCA can reduce incidence of anastomotic leakage in patients with middlelow rectal cancer who don′t undergo preventive stoma.