Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer
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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.
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).
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.
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.
KeywordsRectal Cancer Inferior Mesenteric Artery High Ligation Left Colic Artery Superior Rectal Artery
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).
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