Objective To investigate the clinical efficacy of laparoscopic radical resection for sigmoid cancer with preservation of the left colic artery (LCA) and superior rectal artery (SRA).
Methods The retrospective cohort study was conducted. The clinicopathological data of 312 patients with sigmoid cancer who were admitted to Cancer Hospital of Chinese Academy of Medical Sciences from January to December 2023 were collected. There were 180 males and 132 females, aged (56±12)years. According to the intraoperative management of the inferior mesenteric artery (IMA) and its branches, all 312 patients were divided into two groups. The 114 patients undergoing laparoscopic radical resection for sigmoid cancer with preservation of the LCA and SRA were divided into the vascular preservation group, and the 198 patients undergoing laparoscopic radical resection for sigmoid cancer with ligation of the root of IMA were divided into the root ligation group. Observa-tion indicators: (1) intraoperative and postoperative conditions; (2) pathological examinations; (3) follow‑up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann‑Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann‑Whitney U test.
Results (1) Intraoperative and postoperative conditions. For patients in the vascular preservation group, the time to postopera-tive first flatus was (2.2±1.1)days, the indwelling time of abdominal drainage tube was (4.0±0.8)days, duration of postoperative hospital stay was (6.1±1.2)days. For patients in the root ligation group, the above indicators were (3.3±1.8)days, (5.5±1.0)days, (7.1±1.1)days. There were significant differences in the above indicators between the two groups of patients (t=-6.63, -15.28, -7.76, P<0.05). (2) Pathological examinations. There was no significant difference in the number of lymph nodes retrieved, the number of positive lymph nodes, the number of No.253 lymph nodes retrieved, vascular tumor thrombus, perineural invasion, and tumor TNM staging between the two groups of patients (P>0.05). (3) Follow‑up. All 180 males patients were followed up for 9(range, 3-14)months. Of the 63 males in the vascular preservation group during the follow‑up period, 62 cases experienced with asympto-matic and mild symptoms of urinary dysfunction and 1 case experienced with moderate symptoms, 61 cases experienced with no dysfunction of erectile dysfunction and 2 cases experienced with mild dysfunction of erectile dysfunction. Of the 117 males in the root ligation group, 114 cases experienced with asymptomatic and mild symptoms of urinary dysfunction and 3 cases experienced with moderate symptoms, 112 cases experienced with no dysfunction of erectile dysfunction and 5 cases experienced with mild dysfunction of erectile dysfunction. There was no significant difference in the above indicators between the two groups of patients (Z=-0.42, -0.36, P>0.05). There was no patient with severe symptoms of urinary dysfunction or severe dysfunction of erectile dysfunction in either of the two groups.
Conclusions Laparoscopic radical resection for sigmoid cancer with preserva-tion of the LCA and SRA is safe and feasible. Compared with the root ligation group, there is no increase in operation time or postoperative complications, and the tumor curative effect is comparable, while patient′s postoperative recovery time is shortened.
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