Oncology Outcomes of Total Mesorectal Excision with Preservation of Both the Superior Rectum Artery and Left Colonic Artery for Upper-Rectal and Sigmoid Colon Cancers: A Meta-Analysis

Background: Total mesorectal resection (TME) has become the standard surgical procedure for resection of colorectal cancer tumors. We presented a systematic meta-analysis to evaluate the surgical outcomes of laparoscopic TME surgery with preservation or nonpreservation of both the superior rectum artery (SRA) and left colonic artery (LCA) for upper-rectal and sigmoid colon cancers. Methods: The comparative studies were systematically searched on PubMed, Science Direct, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) up to April 2021. Primary outcomes were oncology outcomes. And secondary outcomes involved surgical outcomes of interest and postoperative recovery. Results: Five relevant studies with a total of 761 patients undergoing laparoscopic TME surgery were eligible for meta-analysis. Three hundred seven patients received TME with preservation of both SRA and LCA (Group A), and 454 received TME surgery alone (Group B), respectively. Our results indicated that Group A had a less total postoperative complications (P = .000), lower anastomotic leakage rate (P = .002), shorter length of stay (P = .008), and longer operative time (P = .002). However, there was no significant difference between the two groups in terms of lymph node dissections (P = .188), intraoperative bleeding (P = .474), the first postoperative defecation (P = .943), recurrence rate (P = .547), and conversive rate (P = .504). Conclusions: Based on our meta-analysis, laparoscopic TME surgery with preservation of both the SRA and LCA for upper-rectal and sigmoid colon cancers may significantly receive better clinical and surgical outcomes. More well-designed large sample studies are required to replicate the short-term benefits and long-term oncologic outcomes.