Discussion
postoperative ileus, colorectal cancer, tumor, Urinary retention, anastomotic stenosis, postoperative bleeding, abscess, anastomotic leakage, anastomotic leak, hypertension, postoperative pneumonia, kidney or liver problems, diabetes, heart disease, diabetes
COLORECTAL CANCER, TUMOR, POSTOPERATIVE PNEUMONIA, POSTOPERATIVE COMPLICATIONS, DEEP VEIN THROMBOSIS, DISEASES, WOUND INFECTION, POSTOPERATIVE BLEEDING, LYMPHATIC VESSELS, ABSCESS, ANASTOMOTIC LEAK, HYPERTENSION, METASTASES, RECTAL CANCER, COMPLICATIONS, DIABETES
We cleaned the lymph nodes at the root of the IMA during laparoscopic rectal cancer radical surgery by preserving the IMA sheath and peeling the IMA sheath. The purpose of designing this trial is to compare the outcomes of lymph node dissection and complications of postoperative between the two surgical methods to explore the advantages and disadvantages of the two surgical methods. The study results indicate that peeling the IMA sheath does not significantly increase the number of lymph node dissection in patients, and does not demonstrate a significant advantage in postoperative complications. However, it can increase the time for surgery and anesthesia in patients.TNM staging (which involves the number of positive lymph nodes) plays an important role in the treatment strategy and prognosis of colorectal cancer, including in peel or laparoscopic surgery or even surgery assisted by the da Vinci robot. Before the appearance of distant metastases, lymph node metastasis is a critical prognostic factor for patients with colorectal cancer and is related to the subsequent treatment plan and course of treatment [The lymph nodes at the root of the IMA are classified as third station lymph nodes of the sigmoid colon or rectum. Most scholars think that the area for No.253 lymph nodes dissection is delineated by the IMV on the left, the abdominal aorta on the right, the duodenum on the cephalic side and the area of the angle between the IMA and the LCA on the caudal side [The surgical approach of this trial was performed in accordance with the standard laparoscopic radical rectal cancer surgery (Dixon procedure) with preservation of the LCA, while the lymph nodes in No.253 lymph nodes were cleared according to the established requirements for the preserved or peeled groups, and the LCA was preserved because previous research has shown that preserving the LCA in radical rectal cancer surgery can increase the blood supply to the proximal IMA of the colon, provide better conditions for the growth and healing of the anastomosis, reduce the incidence of anastomotic leak and anastomotic stenosis postoperatively and is convenient during laparoscopy [The influence of heteromorphosis of IMA vascular branches on the surgical approach to peeling the sheath should be noted when dissecting No.253 lymph nodes. For IMA vascular typing, Yada [
IMA subtypes: The IMA sheath is the tissue that lies between the outer surface of the IMA and the collagen layer that connects the outermost nerve fibers. It contains collagen fibers, nerves, microvasculature, lymphatic vessels and adipose tissue. Studies have shown that microscopically, the IMA sheath contains only lymphatic vessels without the presence of lymph nodes, and no tumor cells are observed within the IMA sheath in lymph node metastasis-positive cases [On the basis of dissection of the IMA sheath. There are currently two types of lymph node dissection for No.253 lymph nodes, and one is to preserve the IMA sheath surgical approach. Li [In this study, the preserved group had a shorter total operative time than the peeled group. The preservation of the IMA sheath for dissection reduces the operative time, makes the procedure simpler, and reduces the risk of intraoperative anesthetic accidents in patients with a long smoking history, especially those with comorbidities of diabetes, heart disease, kidney or liver problems, which helps to reduce operative risk, improve perioperative safety and improve patient prognosis [The preserved group had significantly shorter times to first flatus and fluid intake than the peeled group. Due to the presence of numerous capillaries and lymphatic vessels within the vascular sheath [There were no cases of postoperative mortality or deep vein thrombosis after the operation. Although there were cases of postoperative bleeding in the preserved and peeled group, they were all controlled by appropriate treatment. There were four anastomotic leakage patients in the peeled group (4/70, 5.7%) and only two in the preserved group (2/71, 2.8%). This might be due to the peeling of the sheath affecting the blood flow to the anastomosis, while the influence of the physical condition of the individual patients could not be excluded. Two of the patients with anastomotic leakage were older (both older than 70 years) or had underlying diseases such as hypertension and diabetes. Both groups had three patients with postoperative pneumonia, and all six patients had a long history of smoking. Data from the 2 groups showed no significant difference in the incidences of wound infection and abscess. The number of patients with postoperative ileus is lower than that in the past because surgeons pay more and more attention to the application of enhanced recovery after surgery (ERAS) concept in clinical work. Only two and three patients in both groups developed postoperative ileus; however, the symptoms were quickly alleviated with appropriate and timely treatment. Urinary retention infrequently occurred in both groups, and the data were not significantly different between the 2 groups (5/71, 7.0% vs. 6/70, 8.6% Although this study shows some significant results, there are still some limitations. First, this study is an independent single-center prospective randomized controlled trial, and further validation of the results is needed in a multicenter prospective study with a large sample size. Second, due to limitations in inclusion or exclusion criteria, further data were not available for some patients who had undergone preoperative radiotherapy or emergency cares, and a separate clinical trial could be designed in the future to verify the efficacy of surgery in this population. Finally, in order to reduce the impact of different surgical methods on No.253 of lymph node dissection, the surgical method adopted in this trial was to preserve the LCA for low anterior resection of rectal cancer. Whether the data brought by other surgical methods are similar to this trial needs further prospective trial to verify.