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
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.
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.
To evaluate the effect of LL of the IMA on genitourinary function and defecation for patients after CRC surgeries.
The meta-analysis methods were adopted to realize the objectives. And statistical analyses were performed using Review Manager 5.3 software.
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.
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.