You Xiaolan, Wang Yuanjie, Chen Zhiyi, Li Wenqi, Xu Ning, Liu Guiyuan, Zhao Xiaojun, Huang Chuanjiang
Department of Gastrointestinal Surgery, Taizhou People's Hospital, Jiangsu Taizhou 225300, China.
Department of Medical Quality and Safety, Taizhou People's Hospital, Jiangsu Taizhou 225300, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Oct 25;20(10):1162-1167.
To evaluate the feasibility, safety, radicality and short-term outcome of preserving left colic artery (LCA) during laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer.
From January 2013 to December 2016,136 patients with mid-lower rectal cancer received laparoscopic TME in the Gastrointestinal Surgery Department of Taizhou People's Hospital of Jiangsu Province. Patients with rectal tumor within 10 cm to the anal verge were enrolled into the study. All the enrolled patients had complete data of pathology and follow-up. Those receiving neoadjuvant chemoradiotherapy, with severe base diseases, multifocal tumor, tumor invasion of surrounding tissues, fixation of tumor, recurrent tumor, complications such as acute ileus, bleeding, perforation were excluded. In this study, 72 patients did not undergo preservation of LCA (high ligation group) and 64 patients underwent preservation of LCA (low ligation group). Operative parameters, clinicopathological data and short-term outcome were collected and compared between two groups.
The baseline data including gender, age, body mass index, tumor stage, and distance of tumor from anal verge of two groups were comparable (P>0.05). The differences between two groups about the mean time of operation and the operative blood loss were not significant [(164.0±12.6) min vs. (167.3±9.4) min, (30.0±3.6) ml vs. (30.1±3.0) ml, all P>0.05]. There was no operative death in both groups. Differences in the lymph node dissection (13.7±2.6 vs. 13.3±2.1) and the specimen length of proximal resection margin [(16.4±1.9) cm vs. (16.7±2.1) cm] or distal resection margins [(3.9±0.6) cm vs. (4.1±0.9) cm] between high and low ligation groups were not significant (all P>0.05). Compared with high ligation group, the low ligation group had higher rate of sphincter preservation [92.2% (59/64) vs. 79.2% (57/72), χ=4.580, P=0.032], lower rate of anastomotic leakage [1.6% (1/64) vs. 9.7% (7/72), χ=4.075, P=0.044], anastomotic stenosis [3.1% (2/64) vs. 12.5%(9/72), χ=4.006, P=0.045], and voiding and sexual dysfunction [6.3%(4/64) vs. 18.1%(13/72), χ=4.317, P=0.038]. Mean time of follow-up was 19 months. In high ligation group, the local recurrent rate was 5.56%, distant metastasis rate was 13.89%, overall survival rate was 90.28%, disease-free survival rate was 80.56%, while in low ligation group, the local recurrence rate was 4.69%, distant metastasis rate was 12.50%, overall survival rate was 90.63%, disease-free survival rate was 82.81%, whose differences between two groups were not significant (all P>0.05).
Preservation of LCA during laparoscopic TME for the treatment of rectal cancer is safe and feasible, which can reduce the incidence of anastomotic leakage and stenosis, and voiding and sexual dysfunction.
评估保留左结肠动脉（LCA）在腹腔镜全直肠系膜切除术（TME）治疗直肠癌中的可行性、安全性、根治性及短期疗效。
2013年1月至2016年12月，江苏省泰州市人民医院胃肠外科136例中低位直肠癌患者接受了腹腔镜TME手术。纳入距肛缘10 cm以内的直肠肿瘤患者。所有纳入患者均有完整的病理及随访资料。排除接受新辅助放化疗、有严重基础疾病、多灶性肿瘤、肿瘤侵犯周围组织、肿瘤固定、复发性肿瘤、急性肠梗阻、出血、穿孔等并发症的患者。本研究中，72例患者未保留LCA（高位结扎组），64例患者保留LCA（低位结扎组）。收集两组患者的手术参数、临床病理资料及短期疗效并进行比较。
两组患者的性别、年龄、体重指数、肿瘤分期、肿瘤距肛缘距离等基线资料具有可比性（P>0.05）。两组患者的平均手术时间和术中出血量差异无统计学意义[（164.0±12.6）min对（167.3±9.4）min，（30.0±3.6）ml对（30.1±3.0）ml，均P>0.05]。两组均无手术死亡。高位结扎组与低位结扎组在淋巴结清扫数目（13.7±2.6对13.3±2.1）、近端切缘标本长度[（16.4±1.9）cm对（16.7±2.1）cm]及远端切缘[（3.9±0.6）cm对（4.1±0.9）cm]方面差异均无统计学意义（均P>0.05）。与高位结扎组相比，低位结扎组保肛率更高[92.2%（59/64）对79.2%（57/72），χ=4.580，P=0.032]，吻合口漏发生率更低[1.6%（1/64）对9.7%（7/72），χ=4.075，P=0.044]，吻合口狭窄发生率更低[3.1%（2/64）对12.5%（9/72），χ=4.006，P=0.045]，排尿及性功能障碍发生率更低[6.3%（4/64）对18.1%（13/72），χ=4.317，P=0.038]。平均随访时间为19个月。高位结扎组局部复发率为5.56%，远处转移率为13.89%，总生存率为90.28%，无病生存率为80.56%；低位结扎组局部复发率为4.69%，远处转移率为12.50%，总生存率为90.63%，无病生存率为82.81%，两组差异无统计学意义（均P>0.05）。
腹腔镜TME治疗直肠癌时保留LCA安全可行，可降低吻合口漏、狭窄及排尿和性功能障碍的发生率。
