Journal
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
Volume 37, Issue 3, Pages 709-718Publisher
SPRINGER
DOI: 10.1007/s00384-022-04101-1
Keywords
Inferior mesenteric artery; Artery ligation; Rectal cancer; Anterior resection of the rectum; Total mesorectal excision; Laparoscopic
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This systematic review and meta-analysis investigated the effects of high vs low inferior mesenteric artery ligation on genitourinary and defecatory dysfunction in patients who had undergone rectal cancer resection. The results showed that low ligation was associated with better preservation of genitourinary function and erectile function, but the findings should be interpreted with caution due to heterogeneity, small sample size, and potential bias in the included studies. Further high-quality studies are needed to confirm these results.
Background This systematic review and meta-analysis studied the role of high (HL) versus low (LL) inferior mesenteric artery (IMA) ligation on genitourinary and defecatory dysfunction in patients who had undergone resection for rectal cancer (RC). Methods A systematic literature search of four major databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing HL and LL of IMA in RC surgery were identified. Those studies that looked at genitourinary or defecatory dysfunction were included. Random-effects modeling to summarize statistics was performed. The risk of bias was assessed using Cochrane's Risk-of-Bias tool 2. Results Three RCTs were included. There was clinical heterogeneity with regard to cancer stage and location as well as operative techniques and adjuvant treatments. Functional outcomes (FO) that were reported by at least two studies were International Consultation on Incontinence Questionnaire (ICIQ), International Index for Erectile Function (IIEF), Jorge-Wexner incontinence score (J-W). Difference was observed in ICIQ at 9 months after surgery favoring LL (standard mean difference: - 0.66; 95% confidence intervals (CI): - 0.92, - 0.40; P = 0.37; I 2 =0%). Difference was also observed in IIEF at 9 months favoring LL (mean difference: 7.43; CI: 1.86, 13.00; P = 0.16; I 2 = 50%). Conclusions Although our study has demonstrated the superiority of LL in genitourinary function preservation, these results should be taken with consciousness due to significant heterogeneity between included studies, small sample size, and potential bias. More high-quality studies are needed.
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