Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery
Oncological Outcomes following Rectal Cancer Surgery with High or Low Ligation of the Inferior Mesenteric Artery
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DOI：
10.1159/000477805
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发表时间：
2017-01-01
影响因子：
1.6
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Matsuda, Kenji;Yokoyama, Shozo;Yamaue, Hiroki
背景：直肠癌前切除术中肠系膜下动脉(IMA)结扎的水平与肿瘤预后有关。这项随机对照试验(RCT)的主要终点是评估高位和低位结扎之间的肠功能。这项研究旨在阐明肿瘤学结果作为次要终点。目的：本研究的目的是在一项前瞻性随机对照试验中评估直肠癌IMA结扎水平是否影响肿瘤预后。方法：2008年2月至2011年12月，100例直肠癌前切除术患者被随机分为IMA高位结扎组和低位结扎组。肿瘤学结果是这项随机对照试验的次要终点，而评估肠功能是主要终点。这项随机对照试验已在Clinicaltrials.gov(NCT00701012)注册。结果：除肿瘤分期外，两组间临床资料差异无统计学意义。高位结扎组晚期患者较多(p=0.046)。高结扎组IMA根部无淋巴结转移。高、低结扎组平均收获数分别为16.7个和14.9个。两组患者的无病生存期(DFS)、首次复发部位和总生存期(OS)无明显差异。当患者处于III期时，DFS和OS也没有差异。结论：直肠癌IMA的结扎程度可能不会影响肿瘤预后。然而，需要进一步的大规模研究才能得出这个问题的结论。(C)2017年S.Karger AG，巴塞尔
Background: The level of inferior mesenteric artery (IMA) ligation for anterior resection of rectal cancer has several considerations concerning oncological outcomes. The primary endpoint of this randomized controlled trial (RCT) was to assess bowel function between high and low ligation. This study was intended to clarify oncological outcome as the secondary endpoint. Objective: The aim of this study was to assess in a prospective RCT whether the ligation level of the IMA in rectal cancer influences oncological outcomes. Methods: Between February 2008 and December 2011, 100 patients who underwent anterior resection for rectal cancer were randomized to perform either high or low ligation of the IMA. Oncological outcomes was the secondary endpoint of this RCT, whereas assessing bowel function was the primary endpoint. This RCT was registered at clinicaltrials.gov (NCT00701012). Results: There were no differences between the groups in terms of clinical data except for tumor stage. There were more advanced-stage patients in the high ligation group (p = 0.046). There were no lymph node (LN) metastases in the root of the IMA in the high ligation group. The average number of harvested LNs for the high and low ligation groups was 16.7 and 14.9, respectively. There was no difference in disease-free survival (DFS), site of first recurrence, and overall survival (OS). When patients were in stage III, there was also no difference in DFS and OS. Conclusions: The ligation level of the IMA in rectal cancer may not influence oncological outcomes. However, further large-scale RCTs are needed to conclude this issue. (C) 2017 S. Karger AG, Basel