Analysis Of The Medium To Long-term Clinical Efficacy Of Preserving The Left Colonic Artery During Laparoscopic NOSES For Colorectal Cancer

Objective:To investigate the medium-to long-term clinical efficacy of laparoscopic natural orifice specimen extraction surgery(NOSES)for colorectal cancer with left colonic artery(LCA)preservation,and to provide a basis for the potential population that would benefit from preserving LCA.Methods:The clinical data of patients with rectal and terminal sigmoid colon cancer who underwent laparoscopic natural orifice specimen extraction surgery(NOSES)in the Department of Colorectal Surgery,Sichuan Cancer Hospital from July 2016 to December 2021 were retrospectively collected.According to whether LCA was preserved,cases were divided into the trial group and the control group.The 5-year rates of diseasefree survival(DFS)and overall survival(OS)were compared between two groups.Results:A total of 138 patients were included in this study with a median followup time of 32(4 to 71)months.There were 69 cases each in the trial and control groups,and there was no statistically significant difference between the baseline data of the two groups(P > 0.05).The rates of patients who local recurrence or metastasis and mortality were 4.3% and 2.9% in the trial group,and 8.7% and 2.9% in the control groups,respectively,without statistical differences(all P > 0.05).The 2-year DFS rates after surgery in the two groups were 95.3% versus 98.3%,the 3-year DFS rates were 95.3%versus 88.3%,and the 5-year DFS rates were 95.3% versus 88.3%.The 2-year OS rates in the two groups were 96.8% versus 100%,the 3-year OS rates were 92.4% versus 98.0%,and the 5-year OS rates were 92.4% versus 94.1%.And the differences were significant between the two groups(all P > 0.05).After stratification by TNM stage,the 3-year DFS rates of I stage,II stage and III stage were 96.8%,100% and 84.8% in the trial group,and95.7%,94.4% and 68.4% in the control groups;the 3-year OS rates of I stage,II stage and III stage were 100%,100% and 75.0% in the trial group,and 100%,100% and 92.3%in the control groups,respectively,and the differences were no significant as well(all P >0.05).Conclusion:Preserving the LCA while completely removing the root lymph nodes of the inferior mesenteric artery does not affect the patient’s medium to long-term oncologic outcome,as long as surgical oncologic principles are strictly followed during laparoscopic NOSES for colorectal cancer.