Highlights:
- •Oncological outcomes do not differ according to the level of vascular ligation in rectal resection for cancer.
- •Cancer stage and conversion rate are associated with poor oncological outcomes in rectal cancer
- •Low IMA ligation does not affect survival in laparoscopic TME since the level of the vascular ligation is not one of the risk factors for local or distant disease recurrence
Abstract
Introduction
The oncological outcomes of low ligation (LL) compared to high ligation (HL) of the
inferior mesenteric artery (IMA) during low-anterior rectal resection (LAR) with total
mesorectal excision are still debated. The aim of this study is to report the 5 year
oncologic outcomes of patients undergoing laparoscopic LAR with either HL vs. LL of
the IMA
Materials and methods
Between June 2014 and December 2016, patients who underwent elective laparoscopic
LAR + TME in 6 Italian non-academic hospitals were randomized to HL or LL of IMA after
meeting the inclusion criteria (HighLow trial; ClinicalTrials.gov Identifier NCT02153801). We analyzed the rate of local recurrence, distant metastasis,
overall survival, disease-specific survival, and disease-free survival at 5 years
of patients previously enrolled.
Results
Five-year follow up data were available for 196 patients. Recurrence happened in 42
(21.4%) of patients. There was no statistically significant difference in the distant
recurrence rate (15.8% HL vs. 18.9% LL; P = 0.970) and pelvic recurrence rate (4,9% HL vs 3,2% LL; P = 0.843). No statistically
significant difference was found in 5-year OS (p = 0.545), DSS (p = 0.732) or DFS
(p = 0.985) between HL and LL. Low vs medium and upper rectum site of tumor, conversion
rate, Clavien-Dindo post-operative grade ≥3 complications and tumor stage were found
statistically significantly associated to poor oncological outcomes in univariate
analysis; in multivariate analysis, however, only conversion rate and stage 3 cancer
were found to be independent risk factors for poor DFS at 5 years.
Conclusion
We confirmed the results found in the previous 3-year survival analysis, the level
of inferior mesenteric artery ligation does not affect OS, DSS and DFS at 5-year follow-up.
Keywords
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Article info
Publication history
Published online: October 28, 2022
Accepted:
October 22,
2022
Received in revised form:
October 18,
2022
Received:
July 21,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
