Preservation Of The Arterial Arc Formed By Left Colic Artery,proximal Inferior Mesenteric Artery And The First Branch Of Sigmoid Arteries In Anus Saving Treatment Of Low Rectal Cancer

Background: Preservation of the arterial arc formed by left colic artery,proximal inferior mesenteric artery and the first branch of the sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply and reduce anastomotic tension and leakage rate in an anus-saving treatment of low rectal cancer.Low anterior,ultra-low anterior,and intersphincteric resection are conventional,elective anus-sparing techniques for low rectal cancer and good prognosis depends on a good blood supply and tension-free anastomosis.Aim: The goal is to assess the effect and superiority of preserving the arc formed by the left colic and proximal inferior mesenteric arteries(IMA)and first branch of the sigmoid arteries on the anastomotic blood supply,tension,and leakage rate in anus-sparing surgery for low rectal cancer and to describe our experience.Method: All studies were conducted with Review Manager(Revman)5.3 and SAS 9.0 software.This study was done base on retrospective analysis of 103 patients retrieved from 2011 to 2020.Patients with low rectal cancer resection were grouped into the ligation and preservation group.Among the patients 42 had inferior mesenteric artery ligation and 61 cases had left colic,proximal inferior mesenteric artery and first branch of the sigmoid arteries preservation.To describe our experience,we selected only 62 cases with preservation of the left colic and proximal inferior mesenteric arteries and first branch of the sigmoid artery.Also,for the meta-analysis study,Pub Med,Google scholar and Medline were searched for eligible studies between 1965 to 2018.Surgery time,blood loss,number of resected lymph nodes,anastomotic leakage,ileus,morbidity,hospital length of stay,wound infection and mortality were the main outcome of study.Results: After the operation,patients characteristics,operative results,morbidity and postoperative follow-up results were evaluated.Some of the patients outcome after surgery were comparable between the ligation and preservation group,such as duration of surgery,intraoperative blood loss,postoperative hospital stay and the number of patients with protective stoma(P>0.05).In postoperative morbidity,there were similar results between ligation and preservation groups,particularly anastomotic subclinical dehiscence,bleeding and stricture and urinary retention(P>0.05).There were significant differences in anastomotic leakage and intraabdominal abscess(P<0.05).The 62 patients enrolled for the report included 35 males and 27 females with mean age of 60.13 years.19(31%)of the patient had protective stoma.In postoperative morbidity,2(3.2%)of the patients had urinary retention and 2(3.2%)anastomotic stricture.There was no incidence of intra-abdominal abscess,anastomotic leakage and anastomotic subclinical dehiscence.Furthermore,the 23 studies involved in the meta-analysis included 10,644 patients were data retrieved online.The preservation and non-preservation of LCA was compared and it showed that,NPLCA approach had less operative time(weighted mean difference[WMD]=9.37 min,95% CI [8.92,9.81],p<0.01),less blood loss(weighted mean difference[WMD]=8.28,95% CI [7.43,9.13],p<0.01),and PLCA approach had shorter duration of hospital stay(WMD=-2.84 days,95% CI [-5.49,-0.19],p<0.06)and also anastomotic leakage(WMD=0.79,95% CI [0.67,0.95],p<0.54).No other significant dissimilarities were discovered.Conclusion: Preservation of the arterial arc with dissection of the apical lymph node could increase anastomotic blood supply,reduce anastomotic tension and leakage incidence in anus saving treatment of low rectal cancer.