Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 871-884
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.871
Genitourinary function and defecation after colorectal cancer surgery with low- and high-ligation of the inferior mesenteric artery: A meta-analysis
Xiao Bai, Chun-Dong Zhang, Jun-Peng Pei, Dong-Qiu Dai
Xiao Bai, Chun-Dong Zhang, Jun-Peng Pei, Dong-Qiu Dai, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
Chun-Dong Zhang, Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
Dong-Qiu Dai, Cancer Center, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province , China
Author contributions: Bai X and Dai DQ contributed to the study design; Bai X, Pei JP, and Zhang CD carried out the data collection and selection; Bai X carried out the data analysis and writing of the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Dong-Qiu Dai, MD, PhD, Professor, Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, No. 4 Chongshan East Road, Shenyang 110032, Liaoning Province, China.
Received: April 22, 2021
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
Research background

Whether the benefits of low ligation (LL) of the inferior mesenteric artery (IMA) during colorectal cancer (CRC) surgeries extend to improved genitourinary and defecatory function is still controversial.

Research motivation

Previous studies have demonstrated that LL was associated with a lower risk of postoperative genitourinary and defecatory dysfunction in patients with CRC. One randomized study, however, found that LL was not superior to high ligation (HL) in preserving urinary function. Therefore, we carried out a meta-analysis to systemically compare functional outcomes of patients with CRC between LL and HL of the IMA.

Research objectives

To evaluate the effect of LL of the IMA on genitourinary function and defecation for patients after CRC surgeries.

Research methods

The meta-analysis methods were adopted to realize the objectives. And statistical analyses were performed using Review Manager 5.3 software.

Research results

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.

Research conclusions

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.

Research perspectives

Some limitations in this meta-analysis should be addressed carefully. First, since both randomized controlled trials and non-randomized studies were included, the randomization in the original research was limited. Second, several studies did not evaluate the preoperative genitourinary and bowel function of the patients and functional outcomes were not determined at a consistent time after surgery. In addition, there were differences in the neoadjuvant therapy, adjuvant therapy, surgical approach, and preventive stoma in this analysis. All of these factors may affect the results. Future studies are needed to address these issues.