Autonomic nerve protection via IMA-oriented No.253 lymphadenectomy in rectal cancer surgery with left colic artery preservation

doi:10.3877/cma.j.issn.1674-3946.2026.05.013

Abstract

Abstract:

Objective

To investigate the protective effect of No.253 lymph node dissection centered on the inferior mesenteric artery (IMA) on autonomic nerves during radical resection of rectal cancer with preservation of the left colic artery (LCA).

Methods

A total of 90 patients undergoing radical resection for rectal cancer were prospectively enrolled from January 2020 to June 2025. The patients were divided into three groups using the random number table combined with block randomization, with 30 cases in each group. Group A: LCA non-preservation plus conventional No.253 lymph node dissection; Group B: LCA preservation plus conventional No.253 lymph node dissection; Group C: LCA preservation plus IMA-centered No.253 lymph node dissection. Measurement data conforming to normal distribution were expressed as (

x ¯

±s). One-way analysis of variance was used for intergroup comparison of continuous data. The Pearson χ² test was adopted for enumeration data such as tumor size and tumor stage presented as cases (%). Postoperative survival was analyzed using the Kaplan-Meier method, and the Log-Rank test was performed for comparison. P<0.05 was considered statistically significant.

Results

Compared with Group A, Group B and Group C had longer operative time, shorter time to first flatus and shorter postoperative hospital stay (P<0.05). Group C presented less intraoperative blood loss and faster gastrointestinal function recovery (P<0.05). Compared with Group B, Group C had a shorter recovery time of gastrointestinal function (P<0.05). There were no significant differences among the three groups in the total number of dissected lymph nodes, number of No.253 lymph nodes, lymph node positive rate and circumferential resection margin (CRM) positive rate (P>0.05). For male patients in Group C, the incidence of urinary retention, International Prostate Symptom Score (IPSS), incidence of erectile dysfunction and International Index of Erectile Function-5 (IIEF-5) score were all superior to those in Group A and Group B (P<0.05). For female patients in Group C, the incidence of urinary retention, International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score and Female Sexual Function Index (FSFI) score were also better than those in the other two groups (P<0.05). No significant difference was found in the cumulative disease-free survival rate among the three groups (P>0.05).

Conclusion

In radical resection of rectal cancer with LCA preservation, IMA-centered No.253 lymph node dissection can effectively protect autonomic nerves and improve perioperative recovery indicators, while ensuring adequate lymph node dissection. This surgical technique does not affect patients' disease-free survival, and possesses advantages in nerve protection as well as oncological safety.

Key words: Rectal Neoplasms, Preservation of the Left Colic Artery, Mesenteric Artery, Inferior, Autonomic Nervous System, Lymph Node Excision

Chengyou Liang, Dejiong Yao, Zhigang Ye, Min Wang, Xiaorong Zhang, Shu Fang, Ming Zhu, Jie Liao. Autonomic nerve protection via IMA-oriented No.253 lymphadenectomy in rectal cancer surgery with left colic artery preservation[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(05): 463-467.

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Figures/Tables 6

组别	例数	年龄（岁, $x ¯$ ±s）	性别（例）	BMI（kg/m², $x ¯$ ±s）
组别	例数	年龄（岁, $x ¯$ ±s）	男/女	BMI（kg/m², $x ¯$ ±s）
A组	30	60.3±8.3	18/12	23.6±2.1
B组	30	61.1±7.9	19/11	23.5±2.1
C组	30	60.8±8.2	19/11	23.5±2.1
统计值		F=0.079	χ²=0.095	F=0.011
P值		0.925	0.954	0.989
组别	肿瘤最大径（例）	T分期（例）	N分期（例）
组别	<5/≥5 cm	T_2-3/T₄	N₀/N₁/N₂
A组	15/15	16/14	15/10/5
B组	20/10	15/15	16/9/5
C组	17/13	19/11	14/10/6
统计值	χ²=1.731	χ²=1.170	χ²=0.237
P值	0.420	0.557	0.988

组别	例数	年龄（岁, $x ¯$ ±s）	性别（例）	BMI（kg/m², $x ¯$ ±s）
组别	例数	年龄（岁, $x ¯$ ±s）	男/女	BMI（kg/m², $x ¯$ ±s）
A组	30	60.3±8.3	18/12	23.6±2.1
B组	30	61.1±7.9	19/11	23.5±2.1
C组	30	60.8±8.2	19/11	23.5±2.1
统计值		F=0.079	χ²=0.095	F=0.011
P值		0.925	0.954	0.989
组别	肿瘤最大径（例）	T分期（例）	N分期（例）
组别	<5/≥5 cm	T_2-3/T₄	N₀/N₁/N₂
A组	15/15	16/14	15/10/5
B组	20/10	15/15	16/9/5
C组	17/13	19/11	14/10/6
统计值	χ²=1.731	χ²=1.170	χ²=0.237
P值	0.420	0.557	0.988

组别	例数	手术时间（min）	术中出血量（ml）
A组	30	150.2±20.5	80.6±15.2
B组	30	165.3±22.1^a	75.3±14.8
C组	30	172.5±23.3^a	70.2±13.6^a
F值		8.014	3.837
P值		0.001	0.025
组别	排气时间（d）	胃肠功能恢复时间（d）	术后住院时间（d）
A组	3.2±0.8	4.5±1.0	9.5±1.6
B组	2.8±0.7^a	4.3±0.9	8.8±1.3^a
C组	2.7±0.7^a	3.8±0.8^ab	8.2±1.2^a
F值	4.233	3.289	6.642
P值	0.018	0.042	0.002

组别	例数	淋巴结清扫总数（枚, $x ¯$ ±s）	No.253组淋巴结清扫数（枚, $x ¯$ ±s）	淋巴结阳性[例（%）]	CRM阳性[例（%）]
A组	30	18.5±4.2	3.2±1.1	2(6.7)	2(6.7)
B组	30	19.3±4.5	3.5±1.2	3(10.0)	2(6.7)
C组	30	18.8±4.3	3.3±1.0	2(6.7)	1(3.3)
统计值		F=0.240	F=0.575	χ²=0.310	χ²=0.424
P值		0.787	0.565	0.856	0.809

组别	例数	淋巴结清扫总数（枚, $x ¯$ ±s）	No.253组淋巴结清扫数（枚, $x ¯$ ±s）	淋巴结阳性[例（%）]	CRM阳性[例（%）]
A组	30	18.5±4.2	3.2±1.1	2(6.7)	2(6.7)
B组	30	19.3±4.5	3.5±1.2	3(10.0)	2(6.7)
C组	30	18.8±4.3	3.3±1.0	2(6.7)	1(3.3)
统计值		F=0.240	F=0.575	χ²=0.310	χ²=0.424
P值		0.787	0.565	0.856	0.809

组别	例数	泌尿功能		性功能
组别	例数	尿潴留[例（%）]	IPSS（分, $x ¯$ ±s）	勃起功能障碍[例（%）]	IIEF-5（分, $x ¯$ ±s）
A组	18	3(16.7)	14.1±5.0	10(55.6)	12.8±5.5
B组	19	2(10.5)	10.8±3.9^a	6(31.6)	16.5±4.9^a
C组	19	1(5.3)	8.2±2.6^ab	3(15.8)	19.8±3.9^ab
统计值		-	F=10.422	χ²=6.591	F=9.786
P值		0.028	<0.001	0.037	<0.001

组别	例数	泌尿功能		性功能
组别	例数	尿潴留[例（%）]	IPSS（分, $x ¯$ ±s）	勃起功能障碍[例（%）]	IIEF-5（分, $x ¯$ ±s）
A组	18	3(16.7)	14.1±5.0	10(55.6)	12.8±5.5
B组	19	2(10.5)	10.8±3.9^a	6(31.6)	16.5±4.9^a
C组	19	1(5.3)	8.2±2.6^ab	3(15.8)	19.8±3.9^ab
统计值		-	F=10.422	χ²=6.591	F=9.786
P值		0.028	<0.001	0.037	<0.001

组别	例数	泌尿功能		性功能
组别	例数	尿潴留[例（%）]	ICIQ-FLUTS（分, $x ¯$ ±s）	FSFI（分, $x ¯$ ±s）
A组	12	3(25.0)	12.5±4.3	19.2±4.5
B组	11	1(9.1)	9.3±3.5^a	23.6±4.1^a
C组	11	0	7.3±2.2^ab	26.6±3.2^ab
统计值		-	F=7.209	F=9.780
P值		0.047	0.003	<0.001

组别	例数	泌尿功能		性功能
组别	例数	尿潴留[例（%）]	ICIQ-FLUTS（分, $x ¯$ ±s）	FSFI（分, $x ¯$ ±s）
A组	12	3(25.0)	12.5±4.3	19.2±4.5
B组	11	1(9.1)	9.3±3.5^a	23.6±4.1^a
C组	11	0	7.3±2.2^ab	26.6±3.2^ab
统计值		-	F=7.209	F=9.780
P值		0.047	0.003	<0.001

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