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Int J Colorectal Dis. 2019 Jun;34(6):947-962. doi: 10.1007/s00384-019-03291-5. Epub 2019 Apr 17.

Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis.

Si MB1,2,3, Yan PJ3, Du ZY4, Li LY2, Tian HW2, Jiang WJ1, Jing WT2, Yang J2,3, Han CW2,3, Shi XE5, Yang KH6,7,8, Guo TK9,10,11.

Author information

1
Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China.
2
Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China.
3
Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China.
4
Department of Physiology, Shanxi Medical University, Taiyuan, 030001, People's Republic of China.
5
Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, People's Republic of China.
6
Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China. 15067818123@163.com.
7
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China. 15067818123@163.com.
8
Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China. 15067818123@163.com.
9
Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, People's Republic of China. TiankangGuo2019@163.com.
10
Department of General Surgery, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, People's Republic of China. TiankangGuo2019@163.com.
11
Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, People's Republic of China. TiankangGuo2019@163.com.

Abstract

PURPOSE:

The aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries.

METHODS:

PubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes.

RESULTS:

In total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively.

CONCLUSIONS:

LL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.

KEYWORDS:

Colorectal cancer; High IMA ligation; Low IMA ligation

PMID:
30997603
DOI:
10.1007/s00384-019-03291-5

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