Comparative study on clinical effect of total mesorectal resection for rectal cancer with different IMV ligation levels

doi:10.3877/cma.j.issn.1674-3946.2025.02.007.

Abstract

Abstract:

Objective

To compare and analyze the clinical effect of total mesorectal resection (TME)for rectal cancer at different levels of submesenteric vein (IMV) ligation.

Methods

Sixty patients with rectal cancer undergoing laparoscopic TME from January 2020 to December 2022 were prospectively selected as the study objects, and were divided into high ligation group and low ligation group by random number table method, with 30 cases in each group.The IMV was ligated horizontally at the lower pancreatic margin in the high ligation group, and the IMV was ligated horizontally at the root of the inferior mesenteric artery (IMA) in the low ligation group.SPSS 25.0 was used to complete the data analysis.All perioperative indicators and other measurement data were represented by (x±s) and independent sample t test was performed.The statistical data of postoperative complications were expressed by［ cases (%)］ and χ² test was performed.Kaplan-Meier method was used to draw survival curve and parallel Log-Rank test.P＜0.05 indicated that the difference was statistically significant.

Results

There was no significant difference in operation time, intraoperative blood loss, number of lymph nodes dissection, number of positive lymph nodes, intraperitoneal drainage flow and Wexner score between the two groups (P＞0.05), while the recovery time of intestinal function and postoperative hospital stay in the low ligation group were significantly lower than those in the high ligation group (P＜0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(20.0% vs.16.7%) (P＞0.05).Kaplan-Meier survival analysis showed that cumulative disease-free survival (86.7%vs.83.3%) and cumulative overall survival (90.0% vs.86.7%) were not statistically significant between the high ligation group and the low ligation group (P＞0.05).

Conclusion

Both high ligation and low ligation of IMV in TME of rectal cancer are safe and feasible.Low ligation of IMV is more conducive to postoperative intestinal function recovery of patients, accelerates postoperative rehabilitation and has better clinical effect without affecting radical tumor treatment.

Key words: Rectal Tumor, Total Mesorectal Excision, Inferior Mesenteric Vein, Ligation Level

Congkui Zuo, Yingchun Bi, Qiong Yao. Comparative study on clinical effect of total mesorectal resection for rectal cancer with different IMV ligation levels[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 138-141.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.02.007.

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Figures/Tables 4

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	男/女(例)	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
高位结扎组	30	58.7±8.8	18/12	22.1±3.8
低位结扎组	30	59.1±9.1	16/14	22.5±3.5
t/χ²/Z值		0.173	0.271	0.424
P值		0.432	0.602	0.337
组别	例数	肿瘤距齿状线距离（cm， $\overset{ˉ}{x}$ ±s）	TNM分期(例)	组织学类型(例)
组别	例数	肿瘤距齿状线距离（cm， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ	A/B/C
高位结扎组	30	5.1±1.3	8/14/8	17/5/8
低位结扎组	30	5.2±1.2	9/15/6	19/4/7
t/χ²/Z值		0.310	-0.529	0.289
P值		0.379	0.597	0.886

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ±s）	男/女(例)	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
高位结扎组	30	58.7±8.8	18/12	22.1±3.8
低位结扎组	30	59.1±9.1	16/14	22.5±3.5
t/χ²/Z值		0.173	0.271	0.424
P值		0.432	0.602	0.337
组别	例数	肿瘤距齿状线距离（cm， $\overset{ˉ}{x}$ ±s）	TNM分期(例)	组织学类型(例)
组别	例数	肿瘤距齿状线距离（cm， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ	A/B/C
高位结扎组	30	5.1±1.3	8/14/8	17/5/8
低位结扎组	30	5.2±1.2	9/15/6	19/4/7
t/χ²/Z值		0.310	-0.529	0.289
P值		0.379	0.597	0.886

组别	例数	手术用时（min）	术中失血量（ml）	淋巴结清扫数（枚）	阳性淋巴结数（枚）
高位结扎组	30	232.6±41.3	65.7±30.1	17.3±5.8	3.1±1.2
低位结扎组	30	218.9±43.6	54.6±25.4	18.7±6.3	2.7±1.1
t值		1.249	1.544	0.895	1.346
P值		0.108	0.064	0.187	0.092
组别	例数	腹腔引流量（ml）	肠功能恢复时间（d）	术后住院日（d）	Wexner评分（分）
高位结扎组	30	371.1±123.6	2.6±1.0	9.2±1.6	5.1±1.9
低位结扎组	30	335.7±105.9	2.1±0.8	8.4±1.4	4.5±2.0
t值		1.191	2.138	2.061	1.162
P值		0.119	0.018	0.022	0.125

组别	例数	切口感染	吻合口漏	尿潴留	乳糜漏	骶前脓肿	总并发症
高位结扎组	30	1（3.3）	1（3.3）	1（3.3）	2（6.7）	1（3.3）	6（20.0）
低位结扎组	30	1（3.3）	1（3.3）	2（6.7）	1（3.3）	0（0.0）	5（16.7）
χ ²值		-	-	-	-	-	0.111
P值		-	-	-	-	-	0.739

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