Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China.
Int J Colorectal Dis. 2019 Jun;34(6):947-962. doi: 10.1007/s00384-019-03291-5. Epub 2019 Apr 17.
The aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries.
PubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes.
In total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively.
LL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.
本荟萃分析旨在比较肠系膜下动脉高位结扎（HL）与低位结扎（LL）治疗结直肠癌的效果，并评估这两种手术的淋巴结检出量、生存获益和安全性。
系统检索了 PubMed、Embase、Cochrane 图书馆、Web of Science 和中国生物医学文献数据库（CBM）中比较 HL 与 LL 治疗乙状结肠或直肠肿瘤的相关研究。我们计算了二分类结局的比值比（OR）及其 95%置信区间（CI），并计算了连续性结局的加权均数差（WMD）。
共有 30 项研究纳入本分析。与 LL 相比，HL 治疗组患者吻合口漏和尿道功能障碍的发生风险显著升高（OR=1.29；95%CI=1.08 至 1.55；OR=2.45；95%CI=1.39 至 4.33）。两组间总的淋巴结检出数、肠系膜下动脉根部周围淋巴结检出数、局部复发率和手术时间无显著差异。此外，在所有患者以及 II 期和 III 期患者亚组中，两组间 5 年总生存率和 5 年无病生存率均无统计学差异。
LL 可获得与 HL 相当的淋巴结检出量，且两种术式的生存获益相似。然而，LL 与更低的吻合口漏和尿道功能障碍发生率相关。因此，推荐在结直肠癌手术中采用 LL。
