Yin Tzu-Chieh, Chen Yen-Cheng, Su Wei-Chih, Chen Po-Jung, Chang Tsung-Kun, Huang Ching-Wen, Tsai Hsiang-Lin, Wang Jaw-Yuan
Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Oncol. 2021 Nov 11;11:774782. doi: 10.3389/fonc.2021.774782. eCollection 2021.
Whether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies.
PubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient's perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4.
A total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage ( < 0.001), borderline long operative time ( = 0.06), and less yields of total lymph nodes ( = 0.03) but equivalent IMA root lymph nodes ( = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes.
In comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique.
INPLASY.com, identifier 202190029.
在直肠癌和乙状结肠癌手术中，肠系膜下动脉（IMA）高位或低位结扎哪种更具优势仍存在争议。尽管已经进行了多项荟萃分析，但淋巴结清扫范围界定不清。我们进行了一项荟萃分析，比较IMA高位和低位结扎在乙状结肠癌和直肠癌手术中的效果，重点关注所有纳入研究中IMA根部淋巴结的高位清扫情况。
检索PubMed、MEDLINE和EMBASE数据库，以识别截至2020年发表的相关文章。分析患者的围手术期和肿瘤学结局。使用统计软件RevMan 5.4进行统计分析。
共纳入2011年至2020年间发表的17项研究，其中包括4项随机对照试验。总共有1846例患者接受了IMA低位结扎加淋巴结高位清扫（LL+HD），2648例患者接受了IMA高位结扎（HL）。LL+HD与吻合口漏发生率低（<0.001）、手术时间略长（=0.06）、总淋巴结收获量少（=0.03）但IMA根部淋巴结数量相当（=0.07）相关；此外，LL+HD显示出非劣效的长期肿瘤学结局。
与HL相比，LL+HD是一种治疗乙状结肠癌和直肠癌有效且安全的肿瘤学手术方法。因此，一旦外科医生熟悉该技术，对于乙状结肠癌和直肠癌，建议在左结肠动脉水平以下结扎IMA并进行D3高位清扫。
INPLASY.com，标识符202190029。
