Kato Hisaki, Munakata Shinya, Sakamoto Kazuhiro, Sugimoto Kiichi, Yamamoto Riku, Ueda Shuhei, Tokuda Satoshi, Sakuraba Shunsuke, Kushida Tomoyuki, Orita Hajime, Sakurada Mutsumi, Maekawa Hiroshi, Sato Koichi
Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2295, Japan.
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
J Gastrointest Cancer. 2018 Jul 10. doi: 10.1007/s12029-018-0126-z.
To investigate the effect of left colonic artery (LCA) preservation on laparoscopic sigmoidectomy outcomes METHODS: We identified 447 consecutive patients who underwent laparoscopic sigmoidectomy at our hospital group between January 2010 and December 2016. We divided the patients into groups with and without LCA preservation and with and without anastomotic leakage (AL). We compared the patient age and gender, tumor location, stage, D2/D3 lymph node dissection, comorbidities, operating time, and blood loss between these groups. Univariate and multivariate analyses were performed to determine the risk factors for AL.
There were significant differences in age, sex, tumor location, D2/D3 lymph node dissection, hypertension, operating time, blood loss, and AL for groups with and without LCA preservation. There were significant differences in sex, tumor location, and LCA preservation for groups with and without AL. Multivariate analysis showed male sex (hazard ratio (HR) = 6.37, 95% confidence interval (CI) 2.39-20.6; p < 0.0001), non-LCA preservation (HR = 5.01, 95% CI 1.41-31.8.0; p = 0.01), and rectosigmoidal tumor location (HR = 2.51, 95% CI 1.15-5.61; p = 0.01) as significant independent risk factors for AL.
Based on the results obtained by performing laparoscopic operation for sigmoid colon cancer and rectosigmoid cancer, the LCA preservative procedure is warranted for prevention of AL.
探讨保留左结肠动脉（LCA）对腹腔镜乙状结肠切除术预后的影响。
我们纳入了2010年1月至2016年12月期间在我院连续接受腹腔镜乙状结肠切除术的447例患者。我们将患者分为保留LCA组和未保留LCA组，以及有吻合口漏（AL）组和无吻合口漏组。我们比较了这些组之间的患者年龄、性别、肿瘤位置、分期、D2/D3淋巴结清扫、合并症、手术时间和失血量。进行单因素和多因素分析以确定AL的危险因素。
保留LCA组和未保留LCA组在年龄、性别、肿瘤位置、D2/D3淋巴结清扫、高血压、手术时间、失血量和AL方面存在显著差异。有AL组和无AL组在性别、肿瘤位置和LCA保留方面存在显著差异。多因素分析显示，男性（风险比（HR）=6.37，95%置信区间（CI）2.39 - 20.6；p < 0.0001）、未保留LCA（HR = 5.01，95%CI 1.41 - 31.80；p = 0.01）以及直肠乙状结肠肿瘤位置（HR = 2.51，95%CI 1.15 - 5.61；p = 0.01）是AL的显著独立危险因素。
基于对乙状结肠癌和直肠乙状结肠癌进行腹腔镜手术所获得的结果，保留LCA的手术对于预防AL是必要的。
