A Comparative Study Of Radical Resection Of Rectal Cancer With And Without Preservation Of The Left Colonic Artery

Objective:The aim of the stuty is to compare the clinical effects of radical resection of rectal cancer with(low tie) or without(high tie) reservation of the left colonic artery and to explore the security and rationality of the two surgical methods,which may provide theoretical basis for the choice of the type of resection in rectal cancer surgery. Method:The clinical data of 120 cases of laparotomy radical resection of rectal cancer in our hospital from December 2013 to December 2015 were retrospectively analyzed, including 61 cases with preservation of LCA and 59 cases without preservation of LCA.All cases match the inclusion criteria.(1)To expore the factors affecting the metastasis of lymph nodes around the IMA by using the pathological methods,in order to choose the better procedure by the affecting factors.(2)To compare the Preoperative(operation time,blood loss,and distance from the anal verge) and postoperative parameters(intestinal function recovery time,urinary retention rate,sexual dysfunction rate,anastomotic leakage rate,and defaecatory function) of the two groups. Results:1、The difference is not statistically significant in age,sex,tumor size,depth of tumor invasion,tumor position,histopathologic type,tumor differentiation and the Dukes’ stage between the "low tie" group and the "high tie" group(P>0.05).2、There was no lymph node metastasis to the IMA root on p T1 and p T2 tumor.The rate of metastasis around the IMA root in the p T3 and p T4 was 4.8% and 20% respectly,which was significantly higher than in the p T1 and p T2 tumor.Besides,the rate of metastasis around the IMA root was higher in patients with tumor located upon the peritoneal reflection,low differentiated or nontubular adenocarcinoma.3 、 The difference is not statistically significant in operation time,blood loss,lymph node harvest,anastomotic leakage rate,urinary retention rate,sexual dysfunction rate between the "low tie" group and the "high tie" group(P>0.05).4、The first postoperative mechanical ventilation time was shorter in the "low tie" group than in the "high tie" group,but the difference was not statistically significant(P>0.05).The proportion of patients,who still with increased stool frequncy 3 months after operation,was lower in the "low tie" group than in the "high tie" group,but the difference was not statistically significant(P>0.05).Conclusions:1、The "high tie" may be preferred for patients with tumor located upon the peritoneal reflection,low differentiated,p T3 and p T4 cancer.The rate of metastasis around the IMA root was higher in these patients, so a "high tie" prothdure may bring a more completely lymph node desection around the IMA root.2、There was no difference in the total number of lymph nodes harvested as well as in the anastomotic leakage rate,urinary retention rate,sexual dysfunction rate between the two groups.3、The "low tie" prothdure has advantage of the first postoperative mechanical ventilation time.The proportion of patients with increased stool frequncy after operation was lower in the "low tie" group.