Bai Xiao, Zhang Chun-Dong, Pei Jun-Peng, Dai Dong-Qiu
Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China.
World J Gastrointest Surg. 2021 Aug 27;13(8):871-884. doi: 10.4240/wjgs.v13.i8.871.
The effect of low ligation (LL) high ligation (HL) of the inferior mesenteric artery (IMA) on functional outcomes during sigmoid colon and rectal cancer surgery, including urinary, sexual, and bowel function, is still controversial.
To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer (CRC) surgery.
EMBASE, PubMed, Web of Science, and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL. A total of 14 articles, including 4750 patients, were analyzed using Review Manager 5.3 software. Dichotomous results are expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and continuous outcomes are expressed as weighted mean differences (WMDs) with 95%CIs.
LL resulted in a significantly lower incidence of nocturnal bowel movement (OR = 0.73, 95%CI: 0.55 to 0.97, = 0.03) and anastomotic stenosis (OR = 0.31, 95%CI: 0.16 to 0.62, = 0.0009) compared with HL. The risk of postoperative urinary dysfunction, however, did not differ significantly between the two techniques. The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage, postoperative complications, total lymph nodes harvested, blood loss, operation time, tumor recurrence, mortality, 5-year overall survival rate, or 5-year disease-free survival rate.
Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries, we suggest that LL be preferred over HL.
肠系膜下动脉（IMA）低位结扎（LL）与高位结扎（HL）对乙状结肠和直肠癌手术功能结局（包括泌尿、性功能和肠道功能）的影响仍存在争议。
评估IMA低位结扎对结直肠癌（CRC）手术后泌尿生殖功能和排便的影响。
系统检索EMBASE、PubMed、Web of Science和Cochrane图书馆，以检索描述乙状结肠和直肠癌手术的研究，以便比较LL和HL后的结局。使用Review Manager 5.3软件对总共14篇文章（包括4750例患者）进行分析。二分结果以比值比（OR）和95%置信区间（CI）表示，连续结局以加权平均差（WMD）和95%CI表示。
与HL相比，LL导致夜间排便发生率（OR = 0.73，95%CI：0.55至0.97，P = 0.03）和吻合口狭窄发生率（OR = 0.31，95%CI：0.16至0.62，P = 0.0009）显著降低。然而，两种技术术后泌尿功能障碍的风险没有显著差异。荟萃分析还显示，LL和HL在吻合口漏、术后并发症、总淋巴结收获数、失血量、手术时间、肿瘤复发、死亡率、5年总生存率或5年无病生存率方面没有显著差异。
由于LL可能使CRC手术后肠道功能更好，吻合口狭窄率降低，我们建议LL优于HL。
