Analysis Of The Safety And Feasibility Of Preserving Left Colic Artery During Anus-preserving Rectal Cancer Radical Surgery

Aim: For a long time,there has not been a recognized standard for preserving the left colic artery in radical rectal cancer surgery.This study aims to investigate whether preserving the left colic artery is feasible and safe,whether it will prolong the operation time,and whether there is an advantage compared with high ligation in the occurrence of complications such as anastomotic leakage.Methods: From January 1,2019 to January 1,2022,184 cases of rectal cancer who were hospitalized to the First Department of General Surgery,Shantou Central Hospital,treated by laparoscopic radical rectal cancer(Dixon operation),and meeting the inclusion criteria were retrospectively collected.According to whether the left colic artery was preserved during laparoscopic radical rectal resection,the patients were divided into the control group that did not preserve the left colic artery and directly ligated the root of the inferior rectal artery at a high position,and the observation group that preserved the left colic artery and ligated the inferior mesenteric artery at a low position.Among them,83 patients with preserved left colic artery were included in the observation group,and 101 patients without preserved left colic artery were included in the control group.Results: There were a total of 101 patients in the control group,and a total of 83 patients in the observation group.The average operation time of the observation group was 235.55±63.45 min,and the average operation time of the control group was234.35±55.14 min.There was no significant difference in operation time(P=0.89);The average number of lymph nodes dissected in the control group was 12.26±7.11;the average number of dissected lymph nodes in the observation group was11.78±8.23.The number of lymph nodes dissected in the two groups(Fisher’s exact test value was 21.9,P=0.957);The average intraoperative blood loss in the control group was 43.86±21.99 ml,and the average intraoperative blood loss in the observation group was 40.03±19.12 ml.There was no significant difference in intraoperative bleeding between the two groups(P=0.248).;The average postoperative exhaust and defecation time in the control group was 2.49±1.62 days;The average postoperative exhaust and defecation time in the observation group was 2.36±1.05 days.There was no significant difference in the time of gas and defecation between the two groups(t value was-0.598,P=0.55),The average length of stay in the control group was 15.92±6.75 days,and the average length of stay in the observation group was 15.90±9.93 days;There was no significant difference between the two groups in hospital stay(P=0.989).Although the incidence of anastomotic leakage was 14.90%in the group that did not reserve the left colic artery and ligated the inferior mesenteric artery highly,while the incidence of anastomotic leakage in the group that reserved the left colic artery and ligated the inferior mesenteric artery low was 10.80%,However,there was no significant difference in the incidence of anastomotic leakage between the two groups(P=0.422),and there was no statistical difference in the incidence of total complications between the two groups(P=0.462).Conclusion: The surgical method of preserving the left colic artery is feasible.It can achieve the same degree of lymph node dissection as the high ligation,and does not increase the operation time.However,after Ensuring the adequate blood supply and no significant tension of the anastomosis,reinforcing the anastomotic stoma with barbed wire,making sure there is no active bleeding by washing with a large amount of distilled water,no gastrointestinal fistula,no volvulus and internal fistula before ending the operation,giving ileostomy anal drainage tube when some patients might occur high intraluminal pressure,and other measures to prevent the occurrence of anastomotic leakage,the left colic artery preservation has no obvious advantages in preventing complications such as anastomotic leakage over the high ligation,and the short-term prognosis of the left colic artery preservation method is similar to that of the high ligation.