Objective: To evaluate the feasibility and efficacy of laparoscopic anterior resection of rectal carcinoma with preservation of the left colonic artery.
Methods: From February 2006 to February 2009, 52 patients with rectal carcinoma formerly scheduled for Dixon operation (clinical stage I and II) received laparoscopic Dixon surgery. The inferior mesenteric artery, left colonic artery, sigmoid artery or superior rectal artery, and lymph nodes were dissected through the vasa vasorum approach. The left colonic artery was retained by transecting the inferior mesenteric artery inferior to the left colonic artery. The operative time, intraoperative hemorrhage volume, intraoperative complications, anastomotic tension, number and histopathological features of the dissected lymph nodes surrounding the inferior mesenteric artery, and the rates of local recurrence, lymph node metastasis and anastomotic leakage were analyzed.
Results: The operation was successfully completed in all the 52 cases. The operative time ranged from 115 to 320 min with a mean of 150 min. The mean intraoperative hemorrhage was 25 ml (range 15-75 ml). None of the patients had perforation of the rectum, injuries to blood vessel, ureter or adjacent organs, or anastomotic tension. The number of dissected lymph nodes surrounding the inferior mesenteric artery ranged from 4 to 8, with a mean of 6.2. The dissected lymph nodes in the base of the inferior mesenteric artery showed no cancer cell metastasis, while 4 patients had cancer cell metastasis in the lymph nodes surrounding superior rectal artery. None of patients had anastomotic leakage. Local recurrence was found in only 1 case at 7 months after the operation.
Conclusion: Laparoscopic anterior resection of the rectal carcinoma with preservation of the left colonic artery can be completed in patients with rectal carcinoma planning to receive Dixon operation (clinical stage I or II). This surgical approach preserves more supplying vessels and prevents anastomotic leakage without increasing the anastomotic tension or affecting lymph node dissection surrounding the inferior mesenteric artery.