Top

Published in:

01-12-2013

Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer

Authors: Takao Hinoi, Masazumi Okajima, Manabu Shimomura, Hiroyuki Egi, Hideki Ohdan, Fumio Konishi, Kenichi Sugihara, Masahiko Watanabe

Published in: World Journal of Surgery | Issue 12/2013

Abstract

Background

High morbidity rates related to anastomotic leakage and other factors restrict the application of laparoscopic rectal excision. The aim of the present study was to assess the effect of left colonic artery (LCA) preservation on postoperative complications after laparoscopic rectal excision.

Methods

Data from 888 patients from 28 leading hospitals in Japan who underwent laparoscopic-assisted sphincter-preserving resection of middle and low rectal cancers between 1994 and 2006 were analyzed. The effects of LCA preservation were analyzed among all anterior resection (AR) cases (n = 888) and among AR cases with radical lymph node excision (n = 411).

Results

Among all AR cases, the tumor size, number of lymph nodes collected with evidence of metastasis, TNM factor, and TNM staging were smaller in the LCA preservation group. Regarding complications, the rate of anastomotic leak was significantly higher in the LCA non-preservation group among all AR cases, as well as among AR cases with radical lymph node excision. Nevertheless, there was no difference in survival rate between LCA preservation group and non-preservation group, as measured by the Kaplan–Meier method.

Conclusions

Our data suggest that the preservation of the LCA in laparoscopic AR for middle and low rectal cancer is associated with lower anastomotic leak rates.

Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst 91:916–932PubMedCrossRef

Sobin LH, Hermanek P, Hutter RV (1988) TNM classification of malignant tumors. A comparison between the new (1987) and the old editions. Cancer 61:2310–2314PubMedCrossRef

Beahrs OH (1992) Staging of cancer of the colon and rectum. Cancer 70:1393–1396PubMedCrossRef

Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–852PubMedCrossRef

Beahrs OH (1982) Colorectal cancer staging as a prognostic feature. Cancer 50:2615–2617PubMed

Sugarbaker PH, Corlew S (1982) Influence of surgical techniques on survival in patients with colorectal cancer. Dis Colon Rectum 25:545–557PubMedCrossRef

Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef

Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRef

Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRef

10.

Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRef

11.

Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef

12.

Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596PubMedCrossRef

13.

Japanese Society for Cancer of the Colon and Rectum (2009) General rules for clinical and pathological studies on cancer of the colon, rectum and anus (revised version), 7th edn. Kanehara Shuppan, Tokyo

14.

Muto T, Kotake K, Koyama Y (2001) Colorectal cancer statistics in Japan: data from JSCCR registration, 1974–1993. Int J Clin Oncol 6:171–176PubMedCrossRef

15.

Watanabe M (2006) Laparoscopic anterior resection for rectal cancer, 2nd edn. Springer, New York

16.

Zhou ZG, Hu M, Li Y et al (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215PubMedCrossRef

17.

Braga M, Frasson M, Vignali A et al (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471PubMedCrossRef

18.

Lujan J, Valero G, Hernandez QS et al (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989PubMedCrossRef

19.

Ng SS, Leung KL, Lee JF et al (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566PubMedCrossRef

20.

Hida J, Okuno K, Yasutomi M et al (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon Rectum 48:2232–2237PubMedCrossRef

21.

Kobayashi M, Okamoto K, Namikawa T et al (2006) Laparoscopic lymph node dissection around the inferior mesenteric artery for cancer in the lower sigmoid colon and rectum: is D3 lymph node dissection with preservation of the left colic artery feasible? Surg Endosc 20:563–569PubMedCrossRef

22.

Rouffet F, Hay JM, Vacher B et al (1994) Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum 37:651–659PubMedCrossRef

23.

Rosi PA, Cahill WJ, Carey J (1962) A ten year study of hemicolectomy in the treatment of carcinoma of the left half of the colon. Surg Gynecol Obstet 114:15–24PubMed

24.

Pezim ME, Nicholls RJ (1984) Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 200:729–733PubMedCrossRef

25.

Surtees P, Ritchie JK, Phillips RK (1990) High versus low ligation of the inferior mesenteric artery in rectal cancer. Br J Surg 77:618–621PubMedCrossRef

26.

Corder AP, Karanjia ND, Williams JD et al (1992) Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg 79:680–682PubMedCrossRef

27.

Adachi Y, Inomata M, Miyazaki N et al (1998) Distribution of lymph node metastasis and level of inferior mesenteric artery ligation in colorectal cancer. J Clin Gastroenterol 26:179–182PubMedCrossRef

28.

Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon Rectum 40:1205–1218; discussion 1218–1209PubMedCrossRef

29.

Morschel M, Heintz A, Dienes HP et al (1996) Lymph node dissection, stage migration and perioperative risk in rectal carcinoma. Chirurg 67:915–920PubMedCrossRef

30.

Hida J, Okuno K, Yasutomi M et al (2005) Number versus distribution in classifying regional lymph node metastases from colon cancer. J Am Coll Surg 201:217–222PubMedCrossRef

31.

Kanemitsu Y, Hirai T, Komori K et al (2006) Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg 93:609–615PubMedCrossRef

32.

Kachlik D, Baca V (2006) Macroscopic and microscopic intermesenteric communications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 150:121PubMedCrossRef

33.

Rutegard M, Hemmingsson O, Matthiessen P et al (2012) High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 99:127–132PubMedCrossRef

Title: Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer
Authors: Takao Hinoi
Masazumi Okajima
Manabu Shimomura
Hiroyuki Egi
Hideki Ohdan
Fumio Konishi
Kenichi Sugihara
Masahiko Watanabe
Publication date: 01-12-2013
Publisher: Springer US
Published in: World Journal of Surgery / Issue 12/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2194-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of Left Colonic Artery Preservation on Anastomotic Leakage in Laparoscopic Anterior Resection for Middle and Low Rectal Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2013

York Mason Procedure to Repair Iatrogenic Rectourinary Fistula

Hepatectomy in Elderly Patients: Does Age Matter?

Value of Scintigraphy for Assessing Delayed Gastric Emptying After Pancreatic Surgery

State of the Art of Robotic Pancreatic Surgery

Attenuation of Postmenopausal Bone Loss in Patients with Transient Hypoparathyroidism After Total Thyroidectomy

Application of Fluorescence in Robotic General Surgery: Review of the Literature and State of the Art