腹腔镜直肠癌根治术中是否保留左结肠动脉的争议与进展

Controversy and progress on whether to retain left colonic artery in radical resection of rectal cancer

2019年日本结直肠癌研究学会(JSCCR)指南推荐进展期直肠癌淋巴结清扫范围应包括肠系膜下血管根部淋巴脂肪组织,但并未明确肠系膜下动脉(IMA)结扎部位;美国国家综合癌症网络(NCCN)指南也未明确是否保留左结肠动脉(LCA)。是否保留LCA的争议主要集中在不影响患者肿瘤学结局的前提下,能否同时降低吻合口并发症发生率或术后功能损害。本文结合最新研究进展对上述问题进行评述,最终认为,保留LCA的优势被多数研究支持,可改善近端吻合口血供,技术上可达到与IMA高位结扎相同的淋巴结清扫范围,但是否影响患者生存、降低吻合口漏发生率以及改善患者生活质量,尚需更多高质量的循证医学证据。

Japanese Society for Cancer of the Colon and Rectum(JSCCR)guideline 2019 recommended that lymph node dissection for advanced rectal cancer should include the lymphatic adipose tissue at the root of the inferior mesenteric vessels,but the ligation site of the inferior mesenteric artery(IMA)was not determined,and the NCCN guideline did not indicate clearly whether to retain the left colonic artery(LCA).Controversy over whether to retain LCA is no more than whether it can reduce the incidence of anastomotic complications or postoperative functional damage without affecting the patients'oncological outcome.Focusing on the above problems,this paper reviews the latest research progress.In conclusion,it is believed that the advantages of retaining LCA are supported by most studies,which can improve the blood supply of the proximal anastomosis,and technically can achieve the same range of lymph node dissection as IMA high ligation.However,whether it affects the survival of patients,reduces the incidence of anastomotic leakage,and improves the quality of life of patients,more high-quality evidence-based medical evidence is still needed.