Controversy is ongoing on the level of inferior mesenteric artery (IMA) ligation in sigmoid colon or rectal cancer surgery. In the present study, we aimed to reevaluate the mortality and morbidity especially for anastomotic leakage of low tie combined with lymph node dissection (LT+LND) around the inferior mesenteric artery compared with high tie (HT) in sigmoid colon or rectal cancer surgery using propensity score matching (PSM) analyses.
A total of 1895 patients with sigmoid colon or rectal cancer who underwent curative surgery from 2012 to 2017 in Fudan University Shanghai Cancer Center were recruited into this study. After PSM, LT+LND-and HT-matched patients were comparable. Ultimately, 277 patients were ligated at the origin of IMA and 277 patients experienced the preservation of left colic artery plus lymph node dissection around IMA. The survival outcomes and clinicopathological characteristics were reviewed from the database retrospectively.
The median follow-up period was 13.7 months (range from 1 to 69 months). There were no differences in terms of postoperative complication rate and overall survival (OS) as well as disease-free survival (DFS). In the HT group and LT+LND group, the 3-year OS rates were 90.8% and 90.0%, respectively, whereas the 3-year DFS rates were 78.7% and 73.9%, respectively. Further, LT+LND was associated with prolonged operation time and less blood loss.
LT+LND seems to be less invasive and is not inferior to HT from the point of oncological safety. Further prospective studies and long-term follow-up data are needed.
Clinical trial identification
Legal entity responsible for the study
This work was supported by the National Natural Science Foundation of China (Grant NO. 81772599).
The author has declared no conflicts of interest.