Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Jia-Nan Chen; Zheng Liu; Zhi-Jie Wang; Fu-Qiang Zhao; Fang-Ze Wei; Shi-Wen Mei; Hai-Yu Shen; Juan Li; Wei Pei; Zheng Wang; Jun Yu; Qian Liu

doi:10.4251/wjgo.v12.i6.632

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

World J Gastrointest Oncol. 2020 Jun 15;12(6):632-641. doi: 10.4251/wjgo.v12.i6.632.

Authors

Jia-Nan Chen¹, Zheng Liu¹, Zhi-Jie Wang¹, Fu-Qiang Zhao¹, Fang-Ze Wei¹, Shi-Wen Mei¹, Hai-Yu Shen¹, Juan Li¹, Wei Pei¹, Zheng Wang¹, Jun Yu², Qian Liu³

Affiliations

¹ Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China.
² Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States.
³ Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China. fcwpumch@163.com.

Abstract

Background: For laparoscopic rectal cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin from the aorta [high ligation (HL)] or distally to the origin of the left colic artery [low ligation (LL)]. Whether different ligation levels are related to different postoperative complications, operation time, and lymph node yield remains controversial. Therefore, we designed this study to determine the effects of different ligation levels in rectal cancer surgery.

Aim: To investigate the operative results following HL and LL of the IMA in rectal cancer patients.

Methods: From January 2017 to July 2019, this retrospective cohort study collected information from 462 consecutive rectal cancer patients. According to the ligation level, 235 patients were assigned to the HL group while 227 patients were assigned to the LL group. Data regarding the clinical characteristics, surgical characteristics and complications, pathological outcomes and postoperative recovery were obtained and compared between the two groups. A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage (AL).

Results: Compared to the HL group, the LL group had a significantly lower AL rate, with 6 (2.8%) cases in the LL group and 24 (11.0%) cases in the HL group (P = 0.001). The HL group also had a higher diverting stoma rate (16.5% vs 7.5%, P = 0.003). A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL (OR = 3.599; 95%CI: 1.374-9.425; P = 0.009), tumor located below the peritoneal reflection (OR = 2.751; 95%CI: 0.772-3.985; P = 0.031) and age (≥ 65 years) (OR = 2.494; 95%CI: 1.080-5.760; P = 0.032) were risk factors for AL. There were no differences in terms of patient demographics, pathological outcomes, lymph nodes harvested, blood loss, hospital stay and urinary function (P > 0.05).

Conclusion: In rectal cancer surgery, LL should be the preferred method, as it has a lower AL and diverting stoma rate.

Keywords: Anastomotic leakage; Inferior mesenteric artery; Laparoscopy; Ligation; Postoperative complications; Rectal neoplasms.