Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of General Surgery, Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, Jiangsu, China.
Int J Surg. 2018 Apr;52:269-277. doi: 10.1016/j.ijsu.2018.02.054. Epub 2018 Mar 1.
The aim of this study was to conduct a meta-analysis comparing the oncological, intraoperative and safety outcomes in sigmoid and rectal cancer surgery with and without preservation of the left colic artery (LCA).
We searched Medline, Embase, China National Knowledge Infrastructure (CNKI), and PubMed databases for relevant articles published between 1962 and 2017. Randomized and non-randomized clinical trials were identified and included in the study. End-points evaluated included 5-year mortality, number of patients with retrieved positive metastatic lymph nodes (LN) at the root of inferior mesenteric artery (IMA), number of retrieved LNs, morbidity, mortality, recurrence, bowel obstruction, intraoperative blood loss, anastomotic leakage, operation time, surgical site infection and postoperative bleed. Meta-analysis was conducted using RevMan 5.3 software. The odds ratio (OR) with 95% confidence intervals (CI) was used to analyze dichotomous data.
Seventeen studies including 6247 patients were identified for the meta-analysis. Meta-analysis revealed that preserving the LCA was associated with reduced anastomotic leakage rate (OR, 0.78; 95% CI, 0.62-0.98; P = 0.03). There were no significant differences between the two groups with respect to the 5-year mortality, number of retrieved LNs, number of patients with retrieved positive metastatic LNs at the root of IMA, morbidity, mortality, recurrence, bowel obstruction, intraoperative blood loss, operation time, surgical site infection and postoperative bleed.
In comparison with ligating the left colic artery, preserving the left colic artery seems to achieve comparable success with acceptable safety outcomes and we suggest to preserve the LCA in the sigmoid and rectal cancer surgeries. However, more multicenter randomized controlled trials are required to further evaluate the efficacy and safety of preserving the left colic artery in surgeries.
本研究旨在进行荟萃分析，比较保留左结肠动脉（LCA）与不保留左结肠动脉在乙状结肠和直肠手术中的肿瘤学、手术中和安全性结果。
我们检索了 Medline、Embase、中国知网（CNKI）和 PubMed 数据库，以获取 1962 年至 2017 年期间发表的相关文章。确定并纳入了随机和非随机临床试验。评估的终点包括 5 年死亡率、肠系膜下动脉根部检出阳性转移性淋巴结（LNs）的患者数量、检出的 LNs 数量、发病率、死亡率、复发、肠梗阻、术中出血量、吻合口漏、手术时间、手术部位感染和术后出血。使用 RevMan 5.3 软件进行荟萃分析。使用比值比（OR）及其 95%置信区间（CI）分析二项数据。
共确定了 17 项研究，纳入了 6247 名患者进行荟萃分析。荟萃分析显示，保留 LCA 与降低吻合口漏发生率相关（OR，0.78；95%CI，0.62-0.98；P=0.03）。两组在 5 年死亡率、检出的 LNs 数量、肠系膜下动脉根部检出的阳性转移性 LNs 患者数量、发病率、死亡率、复发、肠梗阻、术中出血量、手术时间、手术部位感染和术后出血方面无显著差异。
与结扎左结肠动脉相比，保留左结肠动脉似乎具有可接受的安全性，且取得了相当的成功，我们建议在乙状结肠和直肠手术中保留左结肠动脉。然而，需要更多的多中心随机对照试验来进一步评估保留左结肠动脉在手术中的疗效和安全性。
