The Clinical Value Of Saving The Left Colic Artery In Laparoscopic Resection Of Rectal Cancer

ObjectiveThe purpose of this retrospective study is to analyze the clinical value of saving the left colic artery in laparoscopic resection of rectal cancer when processing inferior mesenteric artery.MethodsThe clinical data of 71 patients who underwent laparoscopic resection of rectal cancer from January 2014 to June 2015 were retrospectively analyzed, these patients were divided into two groups based on saving LCA or not. The amount of bleeding volume, operation time, the number of mesenteric lymph nodes dissected in the operation , the occurrence of anastomotic leakage, recurrence and metastasis after 1 year, were compared.Results1 .General data in two group before operation: No significant difference were found between two groups in gender, age, and the distance between tumors to anal edge (P>0.05).2. The operative characteristics in two group: No significant difference was found between two groups in the bleeding volume[ ( 81.7±19.5 ) ml vs. ( 72.9±21.9)ml, t=1.769, P =0.081 ] , and the number of mesenteric lymph nodes dissected in the operation [ (12.0±2.8) vs.( 12.5±2.6), t=-0.803, P =0.425] . The operation time in saving LCA group was longer than the other group[ (135.6±27.2) min vs.(124.9±38.3) min].3.The complications after operation in two group3.1None of anastomotic leakage occurred in the saving LCA group, while four cases of anastomotic leakage occurred in no saving LCA group.3.2Postoperative pathological examination: 6 cases were found with lymph node metastasis in T3 stage of the 31 patients,while 5 cases of lymph nodes were found in T4 stage of the 11 patients,otherwise the metastasis rate of apical lymph node was 3.8%.The most pathological type is moderately differentiated adenocarcinoma (about 69.0%). 4 cases occurred postoperative incision infection, 2 cases in each group(5.6%vs. 5.7%). As urinary retention, 2 cases were found in saving LCA group ,and 3 cases in no saving LCA group. A total of 3 cases were found poor control in defecation after operative(1 vs. 2). About 2 cases occurred postoperative ileus, 1 case in each group. As sexual dysfunction, 3 cases were found in saving LCA group ,and 1 cases in no saving LCA group.3.3 The one-year follow-up results of the two groups : 2 cases were found with liver metastasis in the saving LCA group ,while 3 cases were found with liver metastasis in no saving LCA(P=0.620).Conclusion1 .Laparoscopic rectal cancer resection is safe and effective, with the advantages of smaller incision, less trauma, less intraoperative blood loss, faster postoperative recovery, shorter hospitalization time, and less complication.2.Saving LCA in laparoscopic resection of rectal cancer when processing inferior mesenteric artery can effectively guarantee the proximal bowel blood supply, reduce the occurrence of anastomotic leakage, while insure the number of mesenteric lymph nodes dissected in the operation.we believe the method is safe and effective, which is worth popularizing in clinical application.3.Saving LCA does not increase the risk of tumor recurrence after operative.4. As the time of follow-up on patients is shorter and the sample size is small in this study, the long-term curative effect need a wider range clinical studies.