Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis

BackgroundWhether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis com...

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Autores principales:	Tzu-Chieh Yin, Yen-Cheng Chen, Wei-Chih Su, Po-Jung Chen, Tsung-Kun Chang, Ching-Wen Huang, Hsiang-Lin Tsai, Jaw-Yuan Wang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	high ligation low ligation with high dissection sigmoid colon cancer rectal cancer (RC) inferior mesenteric artery (IMA) left colic artery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/056bcb0a3e4b48b1ba12ac6c64ff7c9a
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spelling	oai:doaj.org-article:056bcb0a3e4b48b1ba12ac6c64ff7c9a2021-11-11T07:42:20ZLow Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis2234-943X10.3389/fonc.2021.774782https://doaj.org/article/056bcb0a3e4b48b1ba12ac6c64ff7c9a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.774782/fullhttps://doaj.org/toc/2234-943XBackgroundWhether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies.MethodsPubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient’s perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4.ResultsA total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage (p < 0.001), borderline long operative time (p = 0.06), and less yields of total lymph nodes (p = 0.03) but equivalent IMA root lymph nodes (p = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes.ConclusionIn comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique.Systematic Review RegistrationINPLASY.com, identifier 202190029.Tzu-Chieh YinTzu-Chieh YinTzu-Chieh YinYen-Cheng ChenYen-Cheng ChenWei-Chih SuWei-Chih SuPo-Jung ChenTsung-Kun ChangChing-Wen HuangChing-Wen HuangHsiang-Lin TsaiHsiang-Lin TsaiJaw-Yuan WangJaw-Yuan WangJaw-Yuan WangJaw-Yuan WangJaw-Yuan WangJaw-Yuan WangFrontiers Media S.A.articlehigh ligationlow ligation with high dissectionsigmoid colon cancerrectal cancer (RC)inferior mesenteric artery (IMA)left colic arteryNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	high ligation low ligation with high dissection sigmoid colon cancer rectal cancer (RC) inferior mesenteric artery (IMA) left colic artery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	high ligation low ligation with high dissection sigmoid colon cancer rectal cancer (RC) inferior mesenteric artery (IMA) left colic artery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Po-Jung Chen Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
description	BackgroundWhether high or low ligation of the inferior mesenteric artery (IMA) is superior in surgery for rectal and sigmoid colon cancers remains controversial. Although several meta-analyses have been conducted, the level of lymph node clearance was poorly defined. We performed a meta-analysis comparing high and low ligation of the IMA for sigmoid colon and rectal cancers, with emphasis on high dissection of the lymph node at the IMA root in all the included studies.MethodsPubMed, MEDLINE, and EMBASE databases were searched to identify relevant articles published until 2020. The patient’s perioperative and oncologic outcomes were analyzed. Statistical analysis was performed using the statistical software RevMan version 5.4.ResultsA total of 17 studies, including four randomized controlled trials, published between 2011 and 2020 were selected. In total, 1,846 patients received low ligation of the IMA plus high dissection of lymph nodes (LL+HD), and 2,648 patients received high ligation of the IMA (HL). LL+HD was associated with low incidence of anastomotic leakage (p < 0.001), borderline long operative time (p = 0.06), and less yields of total lymph nodes (p = 0.03) but equivalent IMA root lymph nodes (p = 0.07); moreover, LL+HD exhibited non-inferior long-term oncological outcomes.ConclusionIn comparison with HL, LL+HD was an effective and safe oncological procedure for sigmoid colon and rectal cancers. Therefore, to ligate the IMA below the level of the left colic artery with D3 high dissection for sigmoid colon and rectal cancers might be suggested once the surgeons are familiar with this technique.Systematic Review RegistrationINPLASY.com, identifier 202190029.
format	article
author	Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Po-Jung Chen Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang
author_facet	Tzu-Chieh Yin Tzu-Chieh Yin Tzu-Chieh Yin Yen-Cheng Chen Yen-Cheng Chen Wei-Chih Su Wei-Chih Su Po-Jung Chen Tsung-Kun Chang Ching-Wen Huang Ching-Wen Huang Hsiang-Lin Tsai Hsiang-Lin Tsai Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang Jaw-Yuan Wang
author_sort	Tzu-Chieh Yin
title	Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
title_short	Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
title_full	Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
title_fullStr	Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
title_full_unstemmed	Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis
title_sort	low ligation plus high dissection versus high ligation of the inferior mesenteric artery in sigmoid colon and rectal cancer surgery: a meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/056bcb0a3e4b48b1ba12ac6c64ff7c9a
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Low Ligation Plus High Dissection Versus High Ligation of the Inferior Mesenteric Artery in Sigmoid Colon and Rectal Cancer Surgery: A Meta-Analysis

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