A Study On The Correlation Between Preservation Of Left Colic Artery During Anterior Resection Of Rectal Cancer And Postoperative Anastomotic Leakage

Background: Rectal cancer is a most common gastrointestinal malignancy.Currently,surgical resection such as anterior rectum resection is widely used for rectal cancer.Anastomotic leakage,a most frequent surgical complication after anterior resection of rectal cancer,has become a research focus in recent years.During anterior resection of rectal cancer,compared with high legation of the inferior mesenteric artery(IMA),whether the preservation of the left colic artery(LCA)can radically cure the tumor and reduce postoperative anastomotic is still controversial.Methods: In this study,patients with rectal cancer who received surgical treatment within a limited period from January 2014 to October 2016 in a hospital were included.Based on the preoperative evaluation,the patients underwent traditional anterior resection of rectal cancer(with high ligation of IMA and D3 lymph node dissection)or anterior resection of rectal cancer with LCA preservation and D3 lymph node dissection.The patients’ data,including the operation time,intraoperative blood loss,postoperative hospital stay,postoperative pathologic staging,tumor type,location,size,depth and scope of infiltration,tumor,the distance between the tumor and the anal margin,the incidence of postoperative anastomotic leakage,the incidence of perioperative related complications,hospital mortality,the number of dissected lymph nodes,and the number of dissected No.253 lymph nodes,were recorded.Results: A total of 218 patients with rectal malignant tumor were included in this study.Among them,70 patients received anterior resection of rectal cancer with LCA preservation(LCA group),and the other 148 patients underwent radical resection of rectal cancer with high ligation IMA(traditional group).There were no statistically significant differences between the two groups in age,sex,BMI,preoperative hemoglobin,albumin,platelet,tumor index,tumor size,surgical method,number of dissected lymph nodes,intraoperative blood loss,the distance between the tumor and the anal margin,tumor type,and differentiation type.The operative time of the LCA group was significantly longer than that of the traditional group(159 ± 8.1 vs.93 ±12.3 Min,P = 0.049).Totally,19 patients developed postoperative anastomotic leakage.Univariate analysis showed statistical differences between the patients without postoperative anastomotic leakage and those with it in BMI(18.1 ± 4.6 vs.25.2 ± 4.0.P =0.034),tumor size(3.0 ± 0.7 vs.6.8 ± 1.1 cm,P =0.021),the distance between tumor and the anal margin(9.8 ± 3.4 vs.4.8 ± 2.0 cm,P =0.021),p T stage(P=0.044),and the ratio of patients with preserved LCA(69/130 vs.1/18,P =0.017).Logistic multiple linear regression model analysis showed that larger tumor size(P=0.021),higher BMI(P=0.034),and no LCA preservation(P=0.047)were the final risk factors for anastomotic leakage(risk level=3.67+0.221BMI+1.330 tumor size+3.490 LCA preservation;LCA preservation=0,no LCA preservation=1).ROC curve analysis showed that AUC was 0.821,and the cutoff value of postoperative anastomotic leakage was 12.315.Conclusion: The preservation of LCA in anterior resection of rectal cancer is safe and feasible without increasing the incidence of perioperative complications.Compared with the traditional surgery,there was no significant difference in the total number of dissected lymph nodes or the number of dissected lymph nodes in the central region,suggesting that anterior resection of rectal cancer with LCA preservation did not exert negative impacts on lymph node dissection.Anterior resection of rectal cancer with LCA preservation effectively reduced the incidence of postoperative anastomotic leakage,which could be attributed to the significant improvement of blood supply at the proximal end of the fracture.