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

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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.

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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).

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Authors and Affiliations

  1. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Takao Hinoi, Masazumi Okajima, Manabu Shimomura, Hiroyuki Egi & Hideki Ohdan

  2. Department of Surgery, Jichi Medical University, Shimotsuke, Japan

    Fumio Konishi

  3. Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

  4. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan

    Masahiko Watanabe

Authors
  1. Takao Hinoi
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  2. Masazumi Okajima
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  3. Manabu Shimomura
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  4. Hiroyuki Egi
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  5. Hideki Ohdan
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  6. Fumio Konishi
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  7. Kenichi Sugihara
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  8. Masahiko Watanabe
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Correspondence to Takao Hinoi.

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Hinoi, T., Okajima, M., Shimomura, M. et al. Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer. World J Surg 37, 2935–2943 (2013). https://doi.org/10.1007/s00268-013-2194-3

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  • DOI: https://doi.org/10.1007/s00268-013-2194-3

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