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首页> 外文期刊>World Journal of Surgical Oncology >High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis
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High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis

机译：乙状结肠和直肠癌手术中肠系膜下动脉高位结扎增加了吻合口漏的风险：一项荟萃分析

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The ideal level of ligation of the inferior mesenteric artery (IMA) during curative resection of sigmoid colon and rectal cancer is still controversial. The aim of this meta-analysis was to examine the impact of high ligation and low ligation of the IMA on anastomotic leakage, overall morbidity, postoperative mortality, and oncological outcomes in patients undergoing surgery for sigmoid colon and rectal cancer. PubMed, EMBASE, Web of Science, and BioMed Central databases were searched to identify relevant articles published from May 1953 to March 2018. A total of 18 articles (14 non-randomized studies and 4 randomized clinical trials) were identified. Review Manager 5.3 software was used for analysis of data. The pooled odds ratio (OR) and weighted mean difference (WMD), with 95% CI, were calculated using either the fixed effects model or random effects model. Of the 5917 patients included in this meta-analysis, 3652 patients underwent low ligation of the IMA and 2265 patients underwent high ligation of the IMA. Anastomotic leakage rate was 9.8% in high ligation patients vs. 7.0% in low ligation patients; the risk of anastomotic leakage was significantly higher in high ligation patients (OR?=?1.33; 95% CI 1.10–1.62; P?=?0.004). What is more, overall morbidity was also significantly higher in high ligation patients (OR?=?1.39; 95% CI, 1.05–1.68; P?=?0.05). Postoperative mortality, number of harvested lymph nodes, overall recurrence rate, and 5-year survival rate did not differ significantly between the two groups. Low ligation of the IMA during curative resection of sigmoid colon and rectal cancer appears to be associated with lower risk of anastomotic leakage and overall morbidity. However, there was no significant advantage of low ligation over high ligation of IMA in terms of postoperative mortality, the number of harvested lymph nodes, overall recurrence rate, or 5-year survival rate.
机译：乙状结肠和直肠癌的根治性切除过程中肠系膜下动脉（IMA）的理想结扎水平仍存在争议。这项荟萃分析的目的是检查IMA高结扎率和低结扎率对乙状结肠和直肠癌手术患者的吻合口漏，总体发病率，术后死亡率和肿瘤学结局的影响。搜索PubMed，EMBASE，Web of Science和BioMed Central数据库，以鉴定1953年5月至2018年3月发表的相关文章。共鉴定18篇文章（14项非随机研究和4项随机临床试验）。 Review Manager 5.3软件用于数据分析。使用固定效应模型或随机效应模型计算95％CI的合并比值比（OR）和加权平均差（WMD）。该荟萃分析包括的5917名患者中，有3652例接受了IMA的低结扎术，有2265例接受了IMA的高结扎术。高结扎患者的吻合口漏率为9.8％，低结扎患者为7.0％。高结扎患者的吻合口漏风险明显更高（OR≥1.33; 95％CI 1.10-1.62; P = 0.004）。而且，高结扎患者的总体发病率也显着更高（OR == 1.39; 95％CI，1.05-1.68; P = 0.05）。两组的术后死亡率，收集的淋巴结数目，总复发率和5年生存率无显着差异。在乙状结肠和直肠癌的根治性切除过程中，IMA的低结扎似乎与吻合口漏和整体发病率降低的风险有关。但是，就术后死亡率，收获的淋巴结数目，总体复发率或5年生存率而言，低结扎术比高结扎IMA没有明显优势。

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