Laparoscopic D3 lymph node dissection with left colic artery and first sigmoid artery preservation in rectal cancer

Abstract

Abstract Background D3 lymph node dissection with left colic artery (LCA) preservation in rectal cancer surgery seems to has little effect on reducing postoperative anastomotic leakage. So we first propose D3 lymph node dissection with LCA and first sigmoid artery (SA) preservation. This novel procedure deserves further study. Methods Rectal cancer patients who underwent laparoscopic D3 lymph node dissection with LCA preservation or with LCA and first SA preservation between September 2017 and May 2020 were retrospectively assessed. The patients were categorized into two groups: preservation of LCA group and preservation of LCA and first SA group. A 1:1 propensity score-matched analysis was performed to decrease confounding. Results Propensity score matching yielded 56 patients in each group from the eligible patients. The rate of postoperative anastomotic leakage in the preservation of LCA and first SA group was significantly lower than that in the LCA preservation group (7.1% vs. 0%, P = 0.040). No significant differences were observed in operation time, length of hospital stay, estimated blood loss, length of distal margin, lymph node retrieval, apical lymph node retrieval, and complications. A survival analysis showed patients’ 3-year disease-free survival (DFS) rates of the group 1 and group 2 were 81.8% and 83.5% (P = 0.595), respectively. Conclusion D3 lymph node dissection with LCA and first SA preservation for rectal cancer may help reduce the incidence of anastomotic leakage without compromising oncological outcomes compare with D3 lymph node dissection with only LCA preservation.