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Efficacy of left colic artery preservation with D3 lymph node dissection in laparoscopic surgery for advanced sigmoid and rectal cancer

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Abstract

Purpose

For advanced left colon cancer, lymph node dissection at the root of the inferior mesenteric artery is recommended. Whether the left colic artery (LCA) should be preserved or resected remains contentious.

Methods

The 367 patients who underwent laparoscopic sigmoidectomy or anterior resection and who were pathologically node-positive were reviewed. Patients were divided into LCA-preserving group (LCA-P, n = 60) and LCA-non-preserving group (LCA-NP, n = 307). Propensity score matching was applied to minimize selection bias and 59 patients were matched.

Results

Before matching, the rates of poor performance status and cardiovascular disease were higher in the LCA-P group (p < 0.001). After matching, operation time was longer (276 vs. 240 min, p = 0.001), the frequency of splenic flexure mobilization (62.7% vs. 33.9%, p = 0.003) and lymphovascular invasion (84.7% vs. 55.9%, p = 0.001) was higher in the LCA-P group. Severe postoperative complications (CD ≥ 3) occurred only in the LCA-NP group (0% vs. 8.4%, p = 0.028). The median follow-up period was 38.5 months (range 2.0–70.0 months). The 5-year RFS rates (67.8% vs. 66.0%, p = 0.871) and OS rates (80.4% vs. 74.9%, p = 0.308) were comparable between the groups.

Conclusions

Laparoscopic LCA-sparing surgery for left-sided colorectal cancer reduces the risk of severe complications and offers a favorable long-term prognosis.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Hiroshi Maruta and Tetsuro Tominaga contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hiroshi Maruta, Tetsuro Tominaga, Takashi Nonaka, Terumitsu Sawai & Takeshi Nagayasu

  2. Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan

    Makoto Hisanaga

  3. Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan

    Hiroaki Takeshita

  4. Department of Surgery, Isahaya General Hospital, Isahaya, Japan

    Hidetoshi Fukuoka

  5. Department of Surgery, Ureshino Medical Center, Ureshino, Japan

    Kazuo To

  6. Department of Surgery, Saiseikai Nagasaki Hospital, Saiseikai, Japan

    Kenji Tanaka

Authors
  1. Hiroshi Maruta
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Contributions

HM and TT mainly designed the study. HM analyzed the data. MH, HT, HF, and KT performed surgery. TS and TN supervised this study. All co-authors contributed substantially to this study and fulfilled the requirements for authorship as per the guidelines of the International Committee of Medical Journal Editors. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Tetsuro Tominaga.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

This study was performed in line with the principles of the 1964 Declaration of Helsinki and its later amendments. Approval was granted by the Clinical Research Review Boards of all participating hospitals.

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Informed consent was obtained from all individual participants included in the study.

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Maruta, H., Tominaga, T., Nonaka, T. et al. Efficacy of left colic artery preservation with D3 lymph node dissection in laparoscopic surgery for advanced sigmoid and rectal cancer. Surg Today 53, 1335–1342 (2023). https://doi.org/10.1007/s00595-023-02689-7

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  • DOI: https://doi.org/10.1007/s00595-023-02689-7

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