Laparoscopic D3 Lymph Node Dissection with Left Colic Artery and First Sigmoid Artery Preservation in Rectal Cancer

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2023 Mar 5

PMID 36872346

Authors

Xing Huang

Zhigang Xiao

Zhongcheng Huang

Dan Li

Affiliations

Soon will be listed here.

Abstract

Background: D3 lymph node dissection with left colic artery (LCA) preservation in rectal cancer surgery seems to have little effect on reducing postoperative anastomotic leakage. So we first propose D3 lymph node dissection with LCA and first sigmoid artery (SA) preservation. This novel procedure deserves further study.

Methods: Rectal cancer patients who underwent laparoscopic D3 lymph node dissection with LCA preservation or with LCA and first SA preservation between January 2017 and January 2020 were retrospectively assessed. The patients were categorized into two groups: the preservation of the LCA group and the preservation of the LCA and first SA group. A 1:1 propensity score-matched analysis was performed to decrease confounding.

Results: Propensity score matching yielded 56 patients in each group from the eligible patients. The rate of postoperative anastomotic leakage in the preservation of the LCA and first SA group was significantly lower than that in the LCA preservation group (7.1% vs. 0%, P=0.040). No significant differences were observed in operation time, length of hospital stay, estimated blood loss, length of distal margin, lymph node retrieval, apical lymph node retrieval, and complications. A survival analysis showed patients' 3-year disease-free survival (DFS) rates of group 1 and group 2 were 81.8% and 83.5% (P=0.595), respectively.

Conclusion: D3 lymph node dissection with LCA and first SA preservation for rectal cancer may help reduce the incidence of anastomotic leakage without compromising oncological outcomes compare with D3 lymph node dissection with LCA preservation alone.

Citing Articles

Comparison of short-term surgical outcomes between high and low tie ligation of the inferior mesenteric artery in robotic rectal cancer surgery: a propensity score matching analysis.

Yuan Y, Ju H, Liu Y, Liang Y, Li T, Liu Y J Robot Surg. 2025; 19(1):41.

PMID: 39754668 DOI: 10.1007/s11701-024-02209-w.

References

Wang Y, Wang Y, Zou L, Deng L, Wu T, Liu L . Does the level of inferior mesenteric artery ligation affect short-term and long-term outcomes of patients with sigmoid colon cancer or rectal cancer? A single-center retrospective study. World J Surg Oncol. 2022; 20(1):274. PMC: 9434919. DOI: 10.1186/s12957-022-02741-9. View

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T . Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2019; 25(1):1-42. PMC: 6946738. DOI: 10.1007/s10147-019-01485-z. View

Kang C, Halabi W, Chaudhry O, Nguyen V, Pigazzi A, Carmichael J . Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2012; 148(1):65-71. DOI: 10.1001/2013.jamasurg.2. View

Chang Y, Foo C, Yip J, Wei R, Ng K, Lo O . The impact of indocyanine-green fluorescence angiogram on colorectal resection. Surgeon. 2018; 17(5):270-276. DOI: 10.1016/j.surge.2018.08.006. View

Peng J, Wu H, Li X, Sheng W, Huang D, Guan Z . Prognostic significance of apical lymph node metastasis in patients with node-positive rectal cancer. Colorectal Dis. 2012; 15(1):e13-20. DOI: 10.1111/codi.12055. View

Huang X, Liu H, Liao X, Xiao Z, Huang Z, Li G . Prognostic factors for T1-2 colorectal cancer after radical resection: Lymph node distribution is a valuable predictor of its survival. Asian J Surg. 2020; 44(1):241-246. DOI: 10.1016/j.asjsur.2020.06.013. View

Feng W, Zong Y, Zhao J, Li W, Miao Y, Xu Z . High versus low ligation of the inferior mesenteric artery during laparoscopic rectal cancer surgery: A prospective study of surgical and oncological outcomes. J Surg Oncol. 2021; 123 Suppl 1:S76-S80. DOI: 10.1002/jso.26362. View

Turgeon M, Gamboa A, Regenbogen S, Holder-Murray J, Abdel-Misih S, Hawkins A . A US Rectal Cancer Consortium Study of Inferior Mesenteric Artery Versus Superior Rectal Artery Ligation: How High Do We Need to Go?. Dis Colon Rectum. 2021; 64(10):1198-1211. PMC: 8573719. DOI: 10.1097/DCR.0000000000002052. View

Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V . Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum. 2000; 43(1):76-82. DOI: 10.1007/BF02237248. View

10.

Huang X . Laparoscopic D3 lymph node dissection with left colic artery and sigmoid artery preservation in rectal cancer - a video vignette. Colorectal Dis. 2021; 23(11):3034-3035. DOI: 10.1111/codi.15889. View

11.

Guo Y, Wang D, He L, Zhang Y, Zhao S, Zhang L . Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial. ANZ J Surg. 2015; 87(7-8):576-581. DOI: 10.1111/ans.13032. View

12.

Akagi T, Inomata M, Hara T, Mizusawa J, Katayama H, Shida D . Clinical impact of D3 lymph node dissection with left colic artery (LCA) preservation compared to D3 without LCA preservation: Exploratory subgroup analysis of data from JCOG0404. Ann Gastroenterol Surg. 2020; 4(2):163-169. PMC: 7105844. DOI: 10.1002/ags3.12318. View

13.

Bostrom P, Hultberg D, Haggstrom J, Haapamaki M, Matthiessen P, Rutegard J . Oncological Impact of High Vascular Tie After Surgery for Rectal Cancer: A Nationwide Cohort Study. Ann Surg. 2021; 274(3):e236-e244. DOI: 10.1097/SLA.0000000000003663. View

14.

Thompson S, Chang E, Jobe B . Clinical review: Healing in gastrointestinal anastomoses, part I. Microsurgery. 2006; 26(3):131-6. DOI: 10.1002/micr.20197. View

15.

Higashijima J, Kono T, Shimada M, Sugitani A, Kashihara H, Takasu C . High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection. Front Surg. 2021; 8:756873. PMC: 8710543. DOI: 10.3389/fsurg.2021.756873. View

16.

Kong M, Chen H, Xin Y, Jiang Y, Han Y, Sheng H . High ligation of the inferior mesenteric artery and anastomotic leakage in anterior resection for rectal cancer: a systematic review and meta-analysis of randomized controlled trial studies. Colorectal Dis. 2020; 23(3):614-624. DOI: 10.1111/codi.15419. View

17.

You Y, Hardiman K, Bafford A, Poylin V, Francone T, Davis K . The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum. 2020; 63(9):1191-1222. DOI: 10.1097/DCR.0000000000001762. View

18.

Trastulli S, Munzi G, Desiderio J, Cirocchi R, Rossi M, Parisi A . Indocyanine green fluorescence angiography versus standard intraoperative methods for prevention of anastomotic leak in colorectal surgery: meta-analysis. Br J Surg. 2021; 108(4):359-372. DOI: 10.1093/bjs/znaa139. View

19.

Belloni E, Muttillo E, Di Saverio S, Gasparrini M, Brescia A, Nigri G . The Role of Indocyanine Green Fluorescence in Rectal Cancer Robotic Surgery: A Narrative Review. Cancers (Basel). 2022; 14(10). PMC: 9139806. DOI: 10.3390/cancers14102411. View

20.

Yada H, Sawai K, Taniguchi H, Hoshima M, Katoh M, Takahashi T . Analysis of vascular anatomy and lymph node metastases warrants radical segmental bowel resection for colon cancer. World J Surg. 1997; 21(1):109-15. DOI: 10.1007/s002689900202. View