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Wang X, Li J, Chen W, Yang Q. Preserving the left colonic artery in radical sigmoid and rectal cancer surgery is feasible: A meta-analysis. Medicine (Baltimore) 2024; 103:e37026. [PMID: 38277569 PMCID: PMC10817117 DOI: 10.1097/md.0000000000037026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND This study aims to investigate the safety and feasibility of preserving left colonic artery (LCA) in radical sigmoid and rectal cancer surgery. METHODS Relevant articles were systematically searched on the PubMed, Embase, and Cochrane Library. The quality of included studies was evaluated using the Cochrane Handbook. A meta-analysis was conducted to assess the surgical outcomes and oncological outcomes by RevMan 5.4 software. RESULTS Fifteen studies with a total of 5054 patients, including 2432 patients with LCA preservation and 2622 patients without LCA preservation, were included and analyzed in this study. The meta-analysis revealed that preserving LCA in radical surgery of sigmoid and rectal cancer has lower anastomotic leakage incidence (OR = 1.03, 95% confidence interval = 0.83-1.27, P < .0001). There were no significant differences in the operative time, intraoperative blood loss, number of dissected lymph nodes, postoperative complications as well as the oncological outcomes including systemic recurrence, local recurrence, 5-year overall survival rate, and 5-year disease-free survival rate. CONCLUSION SUBSECTIONS This pooled analysis showed that preserving the LCA is safe and feasible in radical sigmoid and rectal cancer surgery.
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Affiliation(s)
- Xin Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Jianxin Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Wangsheng Chen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Qingqiang Yang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
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Brillantino A, Skokowski J, Ciarleglio FA, Vashist Y, Grillo M, Antropoli C, Herrera Kok JH, Mosca V, De Luca R, Polom K, Talento P, Marano L. Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review. Cancers (Basel) 2023; 16:72. [PMID: 38201499 PMCID: PMC10777981 DOI: 10.3390/cancers16010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: "Is low tie ligation truly reproducible?" Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Jaroslaw Skokowski
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Francesco A. Ciarleglio
- Department of General Surgery and Hepato-Pancreato-Biliary (HPB) Unit—APSS, 38121 Trento, Italy;
| | - Yogesh Vashist
- Department Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Maurizio Grillo
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Carmine Antropoli
- Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy; (A.B.); (M.G.); (C.A.)
| | - Johnn Henry Herrera Kok
- Department of General and Digestive Surgery—Upper GI Unit, University Hospital of León, 24008 León, Spain;
| | - Vinicio Mosca
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy;
| | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Karol Polom
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych—2 Lotnicza Street, 82-300 Elbląg, Poland; (J.S.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, Jana Pawła II 50, 80-462 Gdańsk, Poland
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