A Comparative Study Of Laparosxopic Anterior Resection Of Rectal Carcinoma With And Without Preservation Of The Left Colonic Artery

Objective To explore the necessity and value of preservation of the left colonic artery(LCA)when treating the inferior mesenteric artery in laparoscopic anterior resection o f rectal carcinoma follow the TSME principles.Methods the clinical data of 67 cases of laparoscopic rectal anterior resection in our hospital from January 2010 to December 2013 were retrospectively analyzed,including 35 cases with preservation of LCA and 32 cases without preservation of LCA.Results There were 46 males and 21 females,two groups in age,BMI,tumor size tumor distance from the anal margin,general type,histological type,TNM stage no Significant difference(P>0.05),the operative time,blood loss,postoperative exhaust time,terminal ileum stoma,the number of lymph nodes removed around the root of inferior mesenteric artery(IMA),the rate of lymph node metastasis around the root of IMA and prognosis were compared between the two groups.Results No significant difference was found in intraoperative operative time [(143.10 ± 15.26)min vs.(143.81 ± 13.65)min,t=-0.191,P=0.845],blood loss [(73.06 ± 6.69)ml vs.(70.78 ±7.65)ml,t=1.299,P=0.199],post operative exhaust time[(2.89±0.76)d vs.(3.31 ±0.70)d,t=-1.372,P=0.187],The number of lymph nodes removed around the root of IMA[(2.90 ± 1.30)vs.(3.20 ± 1.12),T=-0.736,P=0.275],the rate of lymph node metastasis around the root of IMA[11.43% vs.9.38%,x2=0.017,P=0.958],between the two groups.No case in the preservation group needed to free the splenic flexure of colon and to make the terminal ileum stoma,while 3 cases of the none preservation group needed to free splenic flexure of colon because of blood supply disorder in the proximal intestine(P=0.046),and 3cases underwent terminal ileum stoma following anastomosis(P=0.031),No anastomotic leakage occurred in the preservation group,while 2 cases of anastomotic leakage occurred in the none-preservation group(P=0.140).In the follow-up of 3 to 48 months(median,24months)of the two groups,1 case had local recurrence,3 cases had liver metastasis in the preservation group while 1 case had local recurrence(P=0.958)and 2 cases had liver metastasis(P=0.692)in the none-preservation group.Conclusion Laparoscopic anterior resection of rectal carcinoma with preservation of the LCA when treating the inferior mesenteric artery can effectively retain the blood supply of proximal intestine.