Genitourinary function and defecation after colorectal cancer surgery with low- and high-ligation of the inferior mesenteric artery: A meta-analysis

Table 1 Characteristics of studies included

Ref.	Year	Country	Design	Surgical treatment (No. patients)		Male (%) LL/HL	Age, yr1		Diagnosis	Stage (No. patients) LL/HL
				LL	HL		LL	HL		Ⅰ	Ⅱ	Ⅲ	Ⅳ
AlSuhaimi et al[15]	2019	South Korea	Retrospective cohort	378	835	63.8/66.2	60.2 ± 11.5	60.6 ± 10.8	Rectal cancer	NA
Chen et al[4]	2020	China	Retrospective cohort	227	235	51.5/54.0	58.6 ± 8.9	57.9 ± 9.1	Rectal cancer	19/24	111/95	97/116
Dimitri et al[18]	2018	Greece	Retrospective cohort	44	76	68.2/51.3	72 (64-77.8)	70 (63-79)	Rectosigmoid and rectal cancer	9/17	16/27	14/26
Fiori et al[5]	2020	Italy	RCT	24	22	58.3/54.4	68 ± 11	68 ± 9	Rectal cancer	24/22
Fujii et al[7]	2019	Japan	RCT	108	107	63.0/63.6	66 (35-88)	66 (30-86)	Rectal cancer	43/45	20/20	36/36	4/3
Kverneng Hultberg et al[20]	2017	England	Retrospective cohort	432	373	52.5/63.0	NA		Rectal cancer	118/86	138/128	137/122	25/24
Lee et al[17]	2018	South Korea	Retrospective cohort	83	51	71.1/66.7	66.6 ± 10.7	66.1 ± 11.5	Sigmoid colon cancer	NA
Matsuda et al[23]	2015	Japan	RCT	49	51	69.4/64.7	67 (45-89)	69 (45-85)	Rectal cancer	17/7	17/15	13/23	2/4
Park et al[14]	2020	South Korea	Retrospective cohort	163	613	65.0/66.4	62 (31-88)	62 (30-86)	Distal sigmoid colon and rectal cancer	51/175	35/146	52/229	10/30
Wang et al[22]	2015	China	RCT	65	63	64.6/60.3	58.6 ± 13.7	56.8 ± 14.2	Rectal cancer	NA
Yasuda et al[21]	2016	Japan	Retrospective cohort	147	42	62.6/61.9	68 ± 9.1	64.5 ± 9.6	Sigmoid colon and rectal cancer	38/2	44/21	65/19
You et al[13]	2020	China	Retrospective cohort	148	174	66.2/67.2	58.1 ± 10.8	57.2 ± 10.5	Rectal cancer	28/38	59/77	59/58
You et al[19]	2017	China	Retrospective cohort	64	72	56.3/58.3	60.1 ± 10.8	58.1 ± 10.9	Rectal cancer	14/16	20/22	29/23
Zhou et al[16]	2018	China	RCT	52	52	61.5/59.6	53.9 ± 13.5	52.7 ± 12.9	Rectal cancer	4/2	23/27	25/23

¹Data expressed as the mean ± SD or median (range). LL: Low ligation; HL: High ligation; NA: Not available; RCT: Randomized clinical trial.

Table 2 Quality assessment of included non-randomized trials based on Newcastle-Ottawa scoring system

Ref.	Year	Selection of the research object	Comparability	Measurement	NOS score
AlSuhaimi et al[15]	2019	3	1	3	7
Chen et al[4]	2020	3	2	2	7
Dimitriou et al[18]	2018	2	1	3	6
Kverneng Hultberg et al[20]	2017	3	1	2	6
Lee et al[17]	2018	2	2	2	6
Park et al[14]	2020	3	1	3	7
Yasuda et al[21]	2016	2	2	3	7
You et al[13]	2020	3	2	3	8
You et al[19]	2017	2	1	3	6

NOS: Newcastle-Ottawa scale.

Table 3 Endpoints of this meta-analysis

Endpoint	No. of patients	No. of studies	LL	HL	OR WMD (95CI)	I2(%)	P value
Functional outcomes
Urinary dysfunction	2029	7	1093	936	OR, 1.23 (0.95-1.59)	25	0.12
Urinary retention	1050	4	301	749	OR, 1.51 (0.85-2.68)	0	0.16
Urinary infection	1617	3	633	984	OR, 0.29 (0.16-0.54)	0	< 0.0001
Genitourinary dysfunction	458	2	212	246	OR, 0.32 (0.17-0.61)	0	0.0006
Nocturnal bowel movement	884	3	461	423	OR, 0.73 (0.55-0,97)	0	0.03
Need for antidiarrheal or laxative drugs	187	2	94	93	OR, 0.70 (0.37-1.30)	14	0.26
Wexner’s incontinence score	274	3	138	136	MD, -0.01 (-0.71-0.70)	76	0.99
Safety outcomes
Anastomotic leakage	4574	13	1830	2744	OR, 0.69 (0.45-1.07)	50	0.10
Anastomotic stenosis	686	4	326	360	OR, 0.31 (0.16-0.62)	46	0.0009
Postoperative complication	2622	5	892	1730	OR, 1.07 (0.66-1.72)	62	0.79
Mortality	822	6	394	428	OR, 2.70 (0.64-11.40)	0	0.18
Operative time	2491	7	996	1495	MD, 4.42 (-2.05-10.89	80	0.18
Blood loss	2357	6	913	1444	MD, -0.63 (-4.01-2.76)	76	0.72
Oncological outcomes
Total lymph nodes harvested	2491	7	996	1495	MD, 0.68 (-1.03-2.38)	94	0.44
Recurrence	1340	8	706	634	OR, 0.97 (0.73-1.30)	0	0.85
5-year overall survival	2821	7	1035	1786	OR, 0.94 (0.61-1.44)	61	0.77
5-year disease-free survival	1523	5	602	921	OR, 0.86 (0.65-1.14)	0	0.29

LL: Low ligation; HL: High ligation; WMD: Weighted mean difference.