Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.871
Peer-review started: April 22, 2021
First decision: June 4, 2021
Revised: June 12, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 27, 2021
The effect of low ligation (LL) vs high ligation (HL) of the inferior mesenteric artery (IMA) on functional outcomes during sigmoid colon and rectal cancer surgery, including urinary, sexual, and bowel function, is still controversial.
To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer (CRC) surgery.
EMBASE, PubMed, Web of Science, and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL. A total of 14 articles, including 4750 patients, were analyzed using Review Manager 5.3 software. Dichotomous results are expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and continuous outcomes are expressed as weighted mean differences (WMDs) with 95%CIs.
LL resulted in a significantly lower incidence of nocturnal bowel movement (OR = 0.73, 95%CI: 0.55 to 0.97, P = 0.03) and anastomotic stenosis (OR = 0.31, 95%CI: 0.16 to 0.62, P = 0.0009) compared with HL. The risk of postoperative urinary dysfunction, however, did not differ significantly between the two techniques. The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage, postoperative complications, total lymph nodes harvested, blood loss, operation time, tumor recurrence, mortality, 5-year overall survival rate, or 5-year disease-free survival rate.
Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries, we suggest that LL be preferred over HL.
Core Tip: It remains unclear whether the benefits of low ligation of the inferior mesenteric artery (IMA) during sigmoid colon and rectal cancer surgeries extend to improved genitourinary and defecatory function. We conducted this meta-analysis to compare low ligation and high ligation of the IMA in terms of functional outcomes, as well as other surgical and long-term survival outcomes.