Chen JN, Liu Z, Wang ZJ, Zhao FQ, Wei FZ, Mei SW, Shen HY, Li J, Pei W, Wang Z, Yu J, Liu Q. Low ligation has a lower anastomotic leakage rate after rectal cancer surgery. World J Gastrointest Oncol 2020; 12(6): 632-641 [PMID: 32699578 DOI: 10.4251/wjgo.v12.i6.632]
Corresponding Author of This Article
Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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Chen JN, Liu Z, Wang ZJ, Zhao FQ, Wei FZ, Mei SW, Shen HY, Li J, Pei W, Wang Z, Yu J, Liu Q. Low ligation has a lower anastomotic leakage rate after rectal cancer surgery. World J Gastrointest Oncol 2020; 12(6): 632-641 [PMID: 32699578 DOI: 10.4251/wjgo.v12.i6.632]
World J Gastrointest Oncol. Jun 15, 2020; 12(6): 632-641 Published online Jun 15, 2020. doi: 10.4251/wjgo.v12.i6.632
Low ligation has a lower anastomotic leakage rate after rectal cancer surgery
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Fu-Qiang Zhao, Fang-Ze Wei, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Jun Yu, Qian Liu
Jia-Nan Chen, Zheng Liu, Zhi-Jie Wang, Fu-Qiang Zhao, Fang-Ze Wei, Shi-Wen Mei, Hai-Yu Shen, Juan Li, Wei Pei, Zheng Wang, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China
Jun Yu, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
Author contributions: Chen JN, Zhao FQ, and Wang ZJ designed the research; Mei SW, Shen HY, Wei FZ and Li J collected the data; Pei W, Wang Z, Liu Z analyzed the data; Chen JN drafted the article; Liu Q and Yu J revised the paper.
Supported bythe Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006; and China Scholarship Council, No. CSC201906210471.
Institutional review board statement: Our investigation received approval from the ethics committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All patients signed informed consent forms.
Conflict-of-interest statement: The authors declare there is no conflict of interest in regard to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have carefully read the STROBE statement checklist of items and prepared the manuscript based on the requirements of the STROBE statement checklist of items.
Corresponding author: Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Received: January 11, 2020 Peer-review started: January 11, 2020 First decision: April 7, 2020 Revised: May 13, 2020 Accepted: May 14, 2020 Article in press: May 14, 2020 Published online: June 15, 2020 Processing time: 155 Days and 10.3 Hours
ARTICLE HIGHLIGHTS
Research background
Rectal cancer is a common malignancy of the digestive tract, and laparoscopic rectal cancer surgery has rapidly replaced open surgery. The ligation level of the inferior mesenteric artery during the surgery remains a controversial topic.
Research motivation
There is a lack of consensus concerning the management of the left colic artery in the low anterior resection of rectal cancer. Whether ligation level is associated with anastomotic leakage (AL) is still under debate. There are limited data regarding surgical outcomes of total mesorectal excision with left colic artery preservation.
Research objectives
The main aim of this study was to investigate whether different ligation levels affect perioperative outcomes.
Research methods
We performed a retrospective cohort study and enrolled rectal cancer patients treated with different ligation levels. Information regarding the clinicopathological features and clinical outcomes were obtained and analyzed. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for AL in rectal cancer patients.
Research results
Preservation of the left colic artery was associated with a significantly lower AL rate. Tumor located below the peritoneal reflection and age (≥ 65 years) were also risk factors for AL.
Research conclusions
Our study showed a lower AL and diverting stoma rate in the left colic artery preservation group. Low ligation should be the preferred method for rectal cancer patients.
Research perspectives
Larger prospective multicenter clinal studies need to be performed so that standard management regarding the left colic artery in rectal cancer can be established.
