| Objectives:At present,laparoscopic surgery is an important treatment for rectal cancer.However,there is no consistent view on the ligation level of the inferior mesenteric artery(IMA).Low ligation is cut the IMA after the left colic artery branching from it,high ligation is cut IMA closely to its root.The advantage of low ligation is to ensure a good blood supply to the anastomosis and it may reduce the risk of anastomotic leakage,hypogastric nerve injury and urinary retention.However,the processing of high ligation is easier and it may reduce anastomotic tension,gain more thorough lymph node dissection and longer survival.Therefore,in order to evaluate the intraoperative situation,postoperative complications and prognosis of these procedures,this study collected clinical data of different IMA ligation levels during laparoscopic rectal cancer radical surgery over the years.Methods:We searched the article from Pubmed,Embase,Cochrane Library and NationalKnowledgeInfrastructure,SinoMed,VIPand Wanfang Data Knowledge Service Platform between inception and February 2019.Randomized controlled trials or clinical controlled trials were included in the study.The study objectives included the operation time,the intraoperative blood loss,total lymph node dissection,the number of root lymph nodes and the incidence of positive lymph nodes of roots,the incidence of anastomotic leakage,anastomotic stenosis,postoperative urination or sexual dysfunction,5-year overall survival and tumor-free survival.This meta-analysis uses Rev Man 5.3 software.For counting data and measurement data,OR and WMD and their 95%confidence interval were used as effect analysis statistics.The heterogeneity between the results of each literature was tested by Q test and I~2 test.All hypothesis tests were two-sided tests with a test level ofα=0.05.Results:Fifteen articles were analyzed in the study,with a total of 2783 patients,1474 patients with high ligation,and 1309 patients with low ligation and D3 lymph node dissection.Compared with low ligation with D3 lymph node dissection,high ligation required shorter operative time(WMD=8.84,95%CI,4.80-12.89,P<0.001).However,the risk of anastomotic leakage(OR=0.45,95%CI 0.32-0.63,P<0.001)and intraoperative splenic flexion(OR=0.06,95%CI 0.01-0.34,P=0.001)in low ligation with D3 lymph node dissection occurred less than high ligation.Low ligation can reduce anastomotic stenosis(OR=0.27,95%CI 0.08-0.96,P=0.04).There were no significant differences in the intraoperative blood loss,total lymph node dissection,the number of root lymph nodes and the incidence of positive lymph nodes of roots,postoperative anastomotic bleeding,incidence of postoperative urination or sexual dysfunction,incidence of low anterior resection syndrome,5-year overall survival and tumor-free survival.Conclusions:In this meta-analysis,it was found that low ligation of IMA with D3lymph node dissection required more operation time than high ligation,but it reduced the risk of postoperative anastomotic leakage.And the incidence of postoperative anastomotic stenosis in low ligation was also lower than that of the high ligation group.At the same time,the intraoperative blood loss,total number of lymph node dissection,total IMA root lymph node dissection,intraoperative protection of the autonomic nervous,5-year overall survival and tumor-free survival in low ligation were not worse than high ligation.Therefore,the preservation of the left colic artery is a safe and effective method for patients with rectal cancer.As the development of the technology,the low ligation with D3 lymph node dissection will be as well as high ligation.However,the results of this study still need to be validated in future large multicenter randomized controlled trials. |
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