Robotic-Assisted or Laparoscopic Radical Resection for Rectal Cancer With or Without Left Colic Artery Preservation

With or Without Left Colic Artery Preservation

Brief Summary

Background The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection.

Methods Participants who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function.

Study Overview

• Status: Completed
• Conditions: Rectal Cancer; Robotic Assisted Laparoscopic Surgery; Left Colic Artery Stenosis (Diagnosis)
• Intervention / Treatment: Procedure: with or without Left Colic Artery Preservation

Detailed Description

The investigators retrospectively collected data from the medical records of participants who had rectal cancer at Northern Jiangsu People's Hospital, from April 2020 to May 2023. A total of 612 from 1164 cases were included in this study; in 462 cases, the LCA was preserved by LL intraoperatively (LL group), in which 202 cases underwent robotic-assisted laparoscopy (LL-RAL subgroup) and 260 cases underwent laparoscopy (LL-LSC subgroup). While in the remaining 150 cases, the LCA was not preserved by HL intraoperatively (HL group). in which 70 cases underwent robotic-assisted laparoscopy (HL-RAL subgroup) and 80 cases underwent laparoscopy (HL-LSC subgroup).

• Study Type: Observational
• Enrollment (Actual): 1164

Contacts and Locations

Study Locations

• China
  • Jiangsu
    • Yangzhou, Jiangsu, China, 225001
      • Northern Jiangsu People's Hospital Affiliated to Yangzhou University, General Surgery Institute of Yangzhou, Yangzhou University , Yangzhou

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

A total of 612 rectal cancer patients, including 245 (40.0%) men and 367(60.0%) women, were enrolled in this study.

Description

Inclusion Criteria:

• Low anterior resection for rectal cancer
• Postoperative pathological diagnosis of rectal adenocarcinoma
• Informed consent signed prior to surgery.

Exclusion Criteria:

• Recurrent rectal cancer
• Emergency surgery
• Preoperative and intraoperative detection of distant organ metastases or extensive
• Implantation metastases in the abdominal cavity
• Palliative surgery
• A postoperative pathology report that showed residual cancer cells at the proximal or distal resection margin
• No standard chemotherapy for tumor-node-metastasis (TNM) staging II or III after surgery
• Synchronous colorectal carcinoma and other organ tumors
• Incomplete case data.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
with or without Left Colic Artery Preservation
low ligation (LL) group and high ligation (HL) group; low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA	Procedure: with or without Left Colic Artery Preservation; low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence of anastomotic leakage in postoperative patients with or without left colic artery preservation.	Within two weeks after surgery, the patient experienced abdominal pain, fever, and imaging diagnosis showed anastomotic leakage.	2 weeks within the surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The genitourinary function of the patients after the radical resection with or without left colic artery preservation.	The genitourinary function includes urinary dysfunction and sexual dysfunction. Residual urine volume and catheterization retention time for evaluating urinary function. Erectile and ejaculatory grading scores are used to evaluate sexual function.	6 to 12 months after operation

Collaborators and Investigators

• Sponsor: Northern Jiangsu People's Hospital
• Investigators: Study Director: Daorong Wang, M.D., Professor, Northern Jiangsu People's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2020
• Primary Completion (Actual): May 31, 2023
• Study Completion (Actual): December 28, 2023

Study Registration Dates

• First Submitted: April 10, 2024
• First Submitted That Met QC Criteria: April 16, 2024
• First Posted (Actual): April 19, 2024

Study Record Updates

• Last Update Posted (Actual): April 22, 2024
• Last Update Submitted That Met QC Criteria: April 19, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Rectal cancer; Inferior mesenteric artery; Left colic artery; Robotic-assisted laparoscopy; High ligation; Low ligation
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Infant, Newborn, Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Rectal Neoplasms; Colic
• Other Study ID Numbers: jamesdukeryan

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Contains a large amount of personal information about patients and needs to be treated with caution.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No