The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, People's Republic of China.
Department of Radiology, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, People's Republic of China.
World J Surg Oncol. 2022 Sep 1;20(1):274. doi: 10.1186/s12957-022-02741-9.
For sigmoid colon or rectal cancer, a definite consensus regarding the optimal level ligating the inferior mesenteric artery (IMA) has not been reached. We performed this study to determine whether the ligation level significantly affected short-term and long-term outcomes of patients with sigmoid colon or rectal cancer after curative laparoscopic surgery.
Medical records of patients with sigmoid colon or rectal cancer who had undergone curative laparoscopic surgery between January 2008 and December 2014 at the Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine were reviewed. Then, the high tie group (HTG) was compared with the low tie group (LTG) in terms of short-term and long-term outcomes.
Five-hundred ninety patients were included. No significant differences between two groups regarding baseline characteristics existed. HTG had a significantly higher risk of anastomotic fistula than LTG (21/283 vs 11/307, P = 0.040). Additionally, high ligation was proven by multivariate logistic regression analysis to be an independent factor for anastomotic fistula (P = 0.038, OR = 2.232, 95% CI: 1.047-4.758). Furthermore, LT resulted in better preserved urinary function. However, LTG was not significantly different from HTG regarding operative time (P = 0.075), blood transfusion (P = 1.000), estimated blood loss (P = 0.239), 30-day mortality (P = 1.000), ICU stay (P = 0.674), postoperative hospital stay (days) (P = 0.636), bowel obstruction (P = 0.659), ileus (P = 0.637), surgical site infection (SSI) (P = 0.121), number of retrieved lymph nodes (P = 0.501), and number of metastatic lymph nodes (P = 0.131). Subsequently, it was revealed that level of IMA ligation did not significantly influence overall survival (OS) (P = 0.474) and relapse-free survival (RFS) (P = 0.722). Additionally, it was revealed that ligation level did not significantly affect OS (P = 0.460) and RFS (P = 0.979) of patients with stage 1 cancer, which was also observed among patients with stage 2 or stage 3 cancer. Ultimately, ligation level was not an independent predictive factor for either OS or RFS.
HT resulted in a significantly higher incidence of anastomotic fistula and worse preservation of urinary function. Level of IMA ligation did not significantly affect long-term outcomes of patients with sigmoid colon or rectal cancer after curative laparoscopic surgery.
对于乙状结肠或直肠癌，在下肠系膜动脉（IMA）结扎的最佳水平尚未达成明确共识。我们进行这项研究旨在确定在根治性腹腔镜手术后，IMA 结扎水平是否显著影响乙状结肠或直肠癌患者的短期和长期结局。
回顾 2008 年 1 月至 2014 年 12 月期间在广东省中医院胃肠外科接受根治性腹腔镜手术的乙状结肠或直肠癌患者的病历。然后，将高结扎组（HTG）与低结扎组（LTG）在短期和长期结局方面进行比较。
共纳入 590 例患者。两组患者的基线特征无显著差异。HTG 的吻合口瘘发生率明显高于 LTG（21/283 比 11/307，P=0.040）。此外，多因素 logistic 回归分析表明，高结扎是吻合口瘘的独立危险因素（P=0.038，OR=2.232，95%CI：1.047-4.758）。此外，LT 可更好地保留尿功能。然而，LTG 在手术时间（P=0.075）、输血（P=1.000）、估计出血量（P=0.239）、30 天死亡率（P=1.000）、重症监护病房停留时间（P=0.674）、术后住院时间（天）（P=0.636）、肠梗阻（P=0.659）、肠麻痹（P=0.637）、手术部位感染（SSI）（P=0.121）、淋巴结检出数（P=0.501）和转移性淋巴结数（P=0.131）方面与 HTG 无显著差异。随后发现，IMA 结扎水平对总生存（OS）（P=0.474）和无复发生存（RFS）（P=0.722）无显著影响。此外，IMA 结扎水平对 1 期癌症患者的 OS（P=0.460）和 RFS（P=0.979）也无显著影响，在 2 期或 3 期癌症患者中也观察到了这一点。最终，结扎水平不是 OS 或 RFS 的独立预测因素。
HT 导致吻合口瘘发生率明显升高，尿功能保存更差。IMA 结扎水平对根治性腹腔镜手术后乙状结肠或直肠癌患者的长期结局无显著影响。
