Advertisement

World Journal of Surgery

, Volume 37, Issue 12, pp 2935–2943 | Cite as

Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer

  • Takao HinoiEmail author
  • Masazumi Okajima
  • Manabu Shimomura
  • Hiroyuki Egi
  • Hideki Ohdan
  • Fumio Konishi
  • Kenichi Sugihara
  • Masahiko Watanabe
Article

Abstract

Background

High morbidity rates related to anastomotic leakage and other factors restrict the application of laparoscopic rectal excision. The aim of the present study was to assess the effect of left colonic artery (LCA) preservation on postoperative complications after laparoscopic rectal excision.

Methods

Data from 888 patients from 28 leading hospitals in Japan who underwent laparoscopic-assisted sphincter-preserving resection of middle and low rectal cancers between 1994 and 2006 were analyzed. The effects of LCA preservation were analyzed among all anterior resection (AR) cases (n = 888) and among AR cases with radical lymph node excision (n = 411).

Results

Among all AR cases, the tumor size, number of lymph nodes collected with evidence of metastasis, TNM factor, and TNM staging were smaller in the LCA preservation group. Regarding complications, the rate of anastomotic leak was significantly higher in the LCA non-preservation group among all AR cases, as well as among AR cases with radical lymph node excision. Nevertheless, there was no difference in survival rate between LCA preservation group and non-preservation group, as measured by the Kaplan–Meier method.

Conclusions

Our data suggest that the preservation of the LCA in laparoscopic AR for middle and low rectal cancer is associated with lower anastomotic leak rates.

Keywords

Rectal Cancer Inferior Mesenteric Artery High Ligation Left Colic Artery Superior Rectal Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported in part by the Japanese Society for Cancer of the Colon and Rectum. The following institutions and surgeons are the members of the Japan Society of Laparoscopic Colorectal Surgery who participated in this multicenter study: Kokuba Y (Kitasato University; current affiliation: St. Marianna University Yokohama City Seibu Hospital), Kawamura Y (Saitama Medical Center, Jichi Medical School), Miyajima N (Teikyo University Hospital Mizonokuchi; current affiliation: St. Marianna University, Toyoko Hospital), Fukunaga M (Juntendo Urayasu Hospital Juntendo University), Kudo S, Tanaka J (Northern Yokohama Hospital Showa University), Tanigawa N, Okuda J (Osaka Medical University), Nagai H, Horie H (Jichi Medical School), Otsuka K (Iwate Medical University), Fukunaga Y (Osaka City General Hospital; current affiliation: Cancer Institute Hospital), Bandou H (Ishikawa Prefectural Central Hospital), Kitano S, Inomata M (Oita University), Kubo Y (Shikoku Cancer Center), Ichihara T (Nishinomiya Municipal Central Hospital), Hasegawa H (Keio University), Yamamoto S (National Cancer Center; current affiliation: Hiratsuka City Hospital), Ikoma S (Ikoma Hospital), Nishiyama Y (National Hospital Organization, Sagamihara National Hospital), Enomoto M (Tokyo Medical and Dental University), Yamaguchi S (Shizuoka Cancer Center; current affiliation: Saitama Med. University International Medical Center), Sekimoto M (Osaka University; current affiliation: Osaka National Hospital), Masaki T (Kyorin University), Idani H (Fukuyama City Hospital), Sumiyama Y, Saida Y (Toho University Ohashi Medical Center), Munemoto Y (Fukui Saiseikai Hospital), Maeda K, Hanai K (Fujita Health University), Kuroyanagi H (Cancer Institute Hospital; current affiliation: Toranomon Hospital), Ueda K (Kinki University).

References

  1. 1.
    Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst 91:916–932PubMedCrossRefGoogle Scholar
  2. 2.
    Sobin LH, Hermanek P, Hutter RV (1988) TNM classification of malignant tumors. A comparison between the new (1987) and the old editions. Cancer 61:2310–2314PubMedCrossRefGoogle Scholar
  3. 3.
    Beahrs OH (1992) Staging of cancer of the colon and rectum. Cancer 70:1393–1396PubMedCrossRefGoogle Scholar
  4. 4.
    Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–852PubMedCrossRefGoogle Scholar
  5. 5.
    Beahrs OH (1982) Colorectal cancer staging as a prognostic feature. Cancer 50:2615–2617PubMedGoogle Scholar
  6. 6.
    Sugarbaker PH, Corlew S (1982) Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum 25:545–557PubMedCrossRefGoogle Scholar
  7. 7.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  8. 8.
    Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRefGoogle Scholar
  9. 9.
    Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  10. 10.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  11. 11.
    Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRefGoogle Scholar
  12. 12.
    Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRefGoogle Scholar
  13. 13.
    Japanese Society for Cancer of the Colon and Rectum (2009) General rules for clinical and pathological studies on cancer of the colon, rectum and anus (revised version), 7th edn. Kanehara Shuppan, TokyoGoogle Scholar
  14. 14.
    Muto T, Kotake K, Koyama Y (2001) Colorectal cancer statistics in Japan: data from JSCCR registration, 1974–1993. Int J Clin Oncol 6:171–176PubMedCrossRefGoogle Scholar
  15. 15.
    Watanabe M (2006) Laparoscopic anterior resection for rectal cancer, 2nd edn. Springer, New YorkGoogle Scholar
  16. 16.
    Zhou ZG, Hu M, Li Y et al (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215PubMedCrossRefGoogle Scholar
  17. 17.
    Braga M, Frasson M, Vignali A et al (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471PubMedCrossRefGoogle Scholar
  18. 18.
    Lujan J, Valero G, Hernandez QS et al (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989PubMedCrossRefGoogle Scholar
  19. 19.
    Ng SS, Leung KL, Lee JF et al (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566PubMedCrossRefGoogle Scholar
  20. 20.
    Hida J, Okuno K, Yasutomi M et al (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon Rectum 48:2232–2237PubMedCrossRefGoogle Scholar
  21. 21.
    Kobayashi M, Okamoto K, Namikawa T et al (2006) Laparoscopic lymph node dissection around the inferior mesenteric artery for cancer in the lower sigmoid colon and rectum: is D3 lymph node dissection with preservation of the left colic artery feasible? Surg Endosc 20:563–569PubMedCrossRefGoogle Scholar
  22. 22.
    Rouffet F, Hay JM, Vacher B et al (1994) Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum 37:651–659PubMedCrossRefGoogle Scholar
  23. 23.
    Rosi PA, Cahill WJ, Carey J (1962) A ten year study of hemicolectomy in the treatment of carcinoma of the left half of the colon. Surg Gynecol Obstet 114:15–24PubMedGoogle Scholar
  24. 24.
    Pezim ME, Nicholls RJ (1984) Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 200:729–733PubMedCrossRefGoogle Scholar
  25. 25.
    Surtees P, Ritchie JK, Phillips RK (1990) High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 77:618–621PubMedCrossRefGoogle Scholar
  26. 26.
    Corder AP, Karanjia ND, Williams JD et al (1992) Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg 79:680–682PubMedCrossRefGoogle Scholar
  27. 27.
    Adachi Y, Inomata M, Miyazaki N et al (1998) Distribution of lymph node metastasis and level of inferior mesenteric artery ligation in colorectal cancer. J Clin Gastroenterol 26:179–182PubMedCrossRefGoogle Scholar
  28. 28.
    Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum 40:1205–1218; discussion 1218–1209PubMedCrossRefGoogle Scholar
  29. 29.
    Morschel M, Heintz A, Dienes HP et al (1996) Lymph node dissection, stage migration and perioperative risk in rectal carcinoma. Chirurg 67:915–920PubMedCrossRefGoogle Scholar
  30. 30.
    Hida J, Okuno K, Yasutomi M et al (2005) Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg 201:217–222PubMedCrossRefGoogle Scholar
  31. 31.
    Kanemitsu Y, Hirai T, Komori K et al (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93:609–615PubMedCrossRefGoogle Scholar
  32. 32.
    Kachlik D, Baca V (2006) Macroscopic and microscopic intermesenteric communications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 150:121PubMedCrossRefGoogle Scholar
  33. 33.
    Rutegard M, Hemmingsson O, Matthiessen P et al (2012) High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 99:127–132PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Takao Hinoi
    • 1
    Email author
  • Masazumi Okajima
    • 1
  • Manabu Shimomura
    • 1
  • Hiroyuki Egi
    • 1
  • Hideki Ohdan
    • 1
  • Fumio Konishi
    • 2
  • Kenichi Sugihara
    • 3
  • Masahiko Watanabe
    • 4
  1. 1.Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Department of SurgeryJichi Medical UniversityShimotsukeJapan
  3. 3.Department of SurgeryTokyo Medical and Dental UniversityTokyoJapan
  4. 4.Department of SurgeryKitasato University School of MedicineSagamiharaJapan

Personalised recommendations