Clinical Study Of Preservation Of Left Colic Artery And Superior Rectal Artery During Laparoscopic Rectal Cancer Resection In The Elderly

Objective:To study the clinical effect of intraoperative preservation of left colic artery and superior rectal artery in elderly patients with rectal cancer,and to explore the feasibility and clinical application evaluation of intraoperative preservation of LCA and SRA in elderly patients.Methods:The clinical data of elderly patients with rectal cancer who underwent Dixon surgery in the Gastrointestinal Surgery Department of our center from January 2017 to January 2022 were retrospectively analyzed.A total of 175 elderly patients with rectal cancer were included in this study,of which 85 cases were preserved with LCA and SRA(observation group);90 cases were not preserved with LCA and SRA(control group).The preoperative,intraoperative and postoperative indicators of the two groups of patients,including age,gender,body mass index,distance from the lower edge of the tumor to the anal verge,underlying diseases,and other general information;operation time,intraoperative blood loss,upward Intraoperative data such as free spleen area and prophylactic stoma;pathological data such as the total number of lymph nodes dissected,the number of IMA root lymph nodes dissected and the number of positive cases;postoperative gastrointestinal function recovery time,postoperative hospital stay,anastomotic leakage(AL)and other complication data,and statistical analysis was performed.The postoperative local recurrence and metastasis rates,postoperative overall survival(OS)and disease free survival(DFS)were statistically analyzed.All statistical analyses in this study were performed by SPSS25.0 software.Result:1.Comparison of general data: There were no significant differences in age,gender,body mass index(BMI),preoperative albumin,preoperative CEA,preoperative CA199,hypertension,diabetes mellitus,hyperlipidemia,arteriosclerosis,smoking,drinking,the distance between the lower edge of the tumor and the anal verge,the preoperative T stage of the tumor,and the degree of tumor differentiation in the preoperative colonoscopy pathological examination(P>0.05).2.Comparison of intraoperative and postoperative recovery: The operation time of the observation group was longer than that of the control group:(180.1±39.7)min vs(166.5±43.3)min,(P<0.05);there was no significant difference in intraoperative blood loss between the observation group and the control group: 70(50,100)ml vs 60(40,90)ml,(P>0.05);in order to reduce the tension at the anastomosis and achieve tension-free anastomosis,the spleen area was freed upward in 4 cases in the observation group,and in the control group in 6 cases due to the proximal intestinal canal.The poor blood supply requires excessive resection of the intestinal segment,and the proximal colon cannot be reserved enough to naturally sag,and the colon and spleen area is freed upward.There was no significant difference between the two groups(P>0.05);0 cases in the observation group were prevented.Prophylactic ileostomy was performed in the control group,and 6 cases in the control group received prophylactic ileostomy,of which4 cases underwent prophylactic ileostomy due to poor blood supply at the anastomotic stoma,and 2 cases underwent prophylactic ileostomy due to excessive tension behind the free spleen area.The difference between the two groups was statistically significant(P<0.05).The time of the first exhaust gas and the time of the first liquid food in the observation group were earlier than those in the control group:(3.2±1.6)d VS(3.7±1.7)d,(4.0±1.7)d VS(4.5±1.7)d,there were statistical differences.The postoperative hospital stay in the observation group was shorter than that in the control group:(8.9±3.4)d VS(10.1±4.2)d,the difference was statistically significant(P<0.05);the incidence of postoperative complications in the observation group was lower than that in the control group: 9 cases VS 21 cases,the difference was statistically significant(P<0.05);the incidence of postoperative anastomotic leakage(AL)in the observation group was lower than that in the control group: 1 case VS 8 cases,the difference was statistically significant(P<0.05).3.Comparison of postoperative pathological results: There was no significant difference in tumor length between the observation group and the control group:(3.5±1.5)cm VS(3.8±1.5)cm,(P>0.05);Comparison of the total number of lymph nodes dissected,the number of IMA root lymph nodes dissected,and the number of positive IMA root lymph nodes between the observation group and the control group:(16.4 ± 2.2)VS(16.7 ± 2.0),(3.0 ± 1.7)VS(3.3 ± 1.8),4 cases vs 6 cases,the difference was not statistically significant(P>0.05).There was no significant difference in tumor TNM staging between the two groups(P>0.05).4.Comparison of follow-up data: the postoperative follow-up time of the two groups was 4-60 months,82 patients in the observation group were followed up,and 86 patients in the control group were followed up.Comparison of recurrence and metastasis between the observation group and the control group: 4 cases VS 3 Cases,9 cases VS 10 cases,the difference was not statistically significant(P>0.05).The Kaplan-Meier method was used to analyze and compare postoperative OS and DFS between the two groups,and there was no significant difference(P>0.05).Conclusion:The results of the study found that the preservation of LCA and SRA during laparoscopic rectal cancer resection in the elderly is safe and feasible,does not increase the amount of intraoperative blood loss,and does not affect the dissection of total lymph nodes and 253 groups of lymph nodes,and the preventive ileostomy is superior to the control group,can promote the recovery of postoperative gastrointestinal function,can reduce the incidence of postoperative anastomotic leakage(AL),and has certain clinical application value for elderly patients with rectal cancer.