Rectal Cancer Clinical Trial
Official title:
A Randomized Controlled Clinical Trial to Investigate the Effects of Total Mesorectum Excision With Left Colic Artery Preservation for the Treatment of Rectal Cancer
A randomized controlled clinical trial to compare the short and long term outcomes of left colic artery preservation for the treatment of Rectal Cancer
Rectal cancer is one of most frequently diagnosed cancers and one of the leading causes of
cancer death around the world. Surgery remains the main treatment for rectal cancer.
Anastomosis leakage (AL) is an unresolved, devastating and lethal complication after rectal
cancer surgery and remains to be a serious difficulty for surgeons despite its causes,
preventions and treatments having been extensively studied.
To achieve a radical dissection of lymph nodes, it is necessary to remove the central lymph
nodes at the root of inferior mesenteric artery(IMA) trunk.From the perspectives of lymph
nodes dissection and tension-free anastomosis, it is preferred to perform a high ligation of
IMA. However, there is still a controversy whether IMA should be high ligated or not. The
argument mainly focuses on whether this performance will compromise the blood perfusion of
the proximal limb of the anastomosis leading to the occurrence of AL. Some studies suggested
that a high ligation did not increase the rate of AL. There are still many surgeons prefer
the transection of IMA distal to the left colic artery(LCA) with the intention to preserve a
good blood supply of the left colon after the performance of lymph node dissection around
IMA. Some studies suggests that the preservation of LCA in anterior resection for mid and low
rectal cancer is associated with lower rates of AL. Further investigations are needed to
resolve the controversy.
In this study, eligible patients will be randomly allocated to receive total mesorectal
excision (TME) for rectal cancer either by a high ligation of IMA without preservation of
left colic artery or a low ligation of IMA with preservation of left colic artery.
Postoperative complications, including anastomosis leakage, anastomosis bleeding, will be
recorded. Patients will be followed up every 3 months for 2 year, every 6 months for 3 years
postoperatively to study the long term effects.
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