Abstract:
Objective
To evaluate the efficacy of preserving the ascending branch of the left colic artery (LCA) during laparoscopic total mesorectal excision for rectal cancer and its effects on surgical stress response and anal function.
Methods
The cases of 100 patients who underwent laparoscopic total mesorectal excision for rectal cancer from August 2021 to August 2023 were included. According to the preservation status of the left colic artery (LCA), they were divided into group A (without preserving LCA, n=50 cases) and group B (preserving LCA, n=50 cases). The general surgical conditions, gastrointestinal hormones, stress response,anal function, and complications were evaluated between the groups. In the statistical analysis, the homogeneity of variance test was first carried out for age, gender, etc. between different groups, the chi-square test was performed for complications, and the t test was conducted for general surgical conditions, gastrointestinal hormones, stress response, and anal function. P<0.05 was considered as a statistically significant difference.
Results
The number of dissected lymph nodes in group B was larger, the operation time was longer, and the recovery time of intestinal function and the time to anal exhaust were shorter (P<0.05). After surgery, the levels of gastrointestinal hormones ［gastrin (GAS), motilin (MTL)］and anal function ［maximum tolerable volume (MTV),length of the high-pressure zone (HPZ), maximum systolic pressure of the anal canal (MSP)］in group B were higher, while the stress response ［aldosterone (ALD), angiotensin II (Ang II), norepinephrine (NE)］was lower(P<0.05). The incidence of complications in group B (4.0%) was lower than that in group A (16.0%) (P<0.05).
Conclusion
Preserving the LCA during laparoscopic total mesorectal excision for rectal cancer may prolong the operation time, but it does not affect the lymph node dissection. Moreover, it can promote the recovery of gastrointestinal function, reduce complications, alleviate the stress response, and reduce the impact on anal function, which has clinical reference significance.
Key words:
Rectal Neoplasms,
Laparoscopic Total Mesangectomy for Rectal Cancer,
Left Colic Artery Preserved,
Stress Response,
Anal Function
Lili Dang, Liu Zhang, Peng Zhou, Huayou Zhou, wei Zhao. Clinical observation of laparoscopic total mesorectal excision with preservation of the ascending branch of the left colic artery for rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 442-445.