Yu Jun, Chen Yi, Li Tong, Sheng Bo, Zhen Zhuo, Liu Chang, Zhang Jianbo, Yan Qian, Zhu Peng
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Surg. 2023 Jan 13;9:1027034. doi: 10.3389/fsurg.2022.1027034. eCollection 2022.
The high or low inferior mesenteric artery (IMA) ligation in rectal cancer remains a great debate. This study retrospectively discussed the outcomes of the perioperative period, defecation and urinary function and long-term prognosis in rectal cancer patients with high or low IMA ligation.
This study enrolled 220 consecutive rectal cancer cases, including 134 with high IMA ligation and 86 with low ligation. A comparison between the two groups was made for anastomotic leakage, low anterior resection syndrome (LARS), international prostate symptom score (IPSS), 5-year disease-free survival (DFS) and 5-year overall survival (OS).
Low-ligation group had a longer operative time, and larger intraoperative blood loss. No significant difference was noted in anastomotic leakage incidence. In multivariable analysis, the male gender and tumor located at the lower rectum were identified as risk factors for anastomotic leakage. No significant differences were observed between groups in their LARS and IPSS questionnaire responses. The high-ligation vs. the low-ligation 5-year OS and DFS were 78.3% vs. 82.4% and 72.4% vs. 76.6%, respectively, which were not statistically different.
The ligation level of the IMA had no significant effect on the anastomotic leakage incidence, defecation, urinary function, and long-term prognosis.
直肠癌中肠系膜下动脉（IMA）高位或低位结扎仍存在很大争议。本研究回顾性探讨了IMA高位或低位结扎的直肠癌患者围手术期结局、排便及泌尿功能和长期预后。
本研究纳入220例连续的直肠癌病例，其中134例行IMA高位结扎，86例行低位结扎。比较两组患者的吻合口漏、低位前切除综合征（LARS）、国际前列腺症状评分（IPSS）、5年无病生存率（DFS）和5年总生存率（OS）。
低位结扎组手术时间较长，术中失血量较大。吻合口漏发生率无显著差异。多变量分析中，男性和肿瘤位于直肠下段被确定为吻合口漏的危险因素。两组在LARS和IPSS问卷回答方面未观察到显著差异。IMA高位结扎与低位结扎的5年OS和DFS分别为78.3%对82.4%和72.4%对76.6%，差异无统计学意义。
IMA的结扎水平对吻合口漏发生率、排便、泌尿功能及长期预后无显著影响。
