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Meta-Analysis
. 2022 Aug 23;58(9):1143.
doi: 10.3390/medicina58091143.

High Versus Low Ligation of the Inferior Mesenteric Artery in Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Kwangmin Kim  1   2 , Sanghyun An  1   3 , Myung Ha Kim  4 , Jae Hung Jung  5   6 , Youngwan Kim  1   3
Affiliations
Meta-Analysis

High Versus Low Ligation of the Inferior Mesenteric Artery in Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Kwangmin Kim et al. Medicina (Kaunas). .

Abstract

Background and Objectives: This study aimed to compare the effects of high ligation (HL) versus low ligation (LL) in colorectal cancer surgery. Materials and Methods: We performed a comprehensive search using multiple databases (trial registries and ClinicalTrials.gov), other sources of grey literature, and conference proceedings, with no restrictions on the language or publication status, up until 10 March 2021. We included all parallel-group randomized controlled trials (RCTs) and considered cluster RCTs for inclusion. The risk of bias domains were "low risk," "high risk," or "unclear risk." We performed statistical analyses using a random-effects model and interpreted the results according to the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE guidelines to rate the certainty of evidence (CoE) of the randomized controlled trials. Results: We found 12 studies (24 articles) from our search. We were very uncertain about the effects of HL on overall mortality, disease recurrence, cancer-specific mortality, postoperative mortality, and anastomotic leakage (very low CoE). There may be little to no difference between HL and LL in postoperative complications (low CoE). For short-term follow-up (within 6 months), HL may reduce defecatory function (constipation; low CoE). While HL and LL may have similar effects on sexual function in men, HL may reduce female sexual function compared with LL (low CoE). For long-term follow-up (beyond 6 months), HL may reduce defecatory function (constipation; low CoE). There were discrepancies in the effects regarding urinary dysfunction according to which questionnaire was used in the studies. HL may reduce male and female sexual function (low CoE). Conclusions: We are very uncertain about the effects of HL on survival outcomes, and there is no difference in the incidence of postoperative complications between HL and LL. More rigorous RCTs are necessary to evaluate the effect of HL and LL on functional outcomes.

Keywords: colorectal cancer; high ligation; inferior mesenteric artery; low ligation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prisma flow chart of this study.
Figure 2
Figure 2
Forest plot of defecatory dysfunction assessed by the overall score of the fecal incontinence quality of life scale (short-term).
Figure 3
Figure 3
Forest plot of defecatory dysfunction assessed by each domain of the fecal incontinence quality of life scale (short-term).
Figure 4
Figure 4
Forest plot of defecatory dysfunction assessed by the overall score of the fecal incontinence quality of life scale (long-term).
Figure 5
Figure 5
Forest plot of defecatory dysfunction assessed by each domain of the fecal incontinence quality of life scale (long-term).
Figure 6
Figure 6
Risk of bias summary: Review authors’ judgments about each risk of bias item for each included study. Subjective outcomes: Postoperative complications, anastomotic leakage, urinary dysfunction, sexual dysfunction, and defecatory dysfunction. Objective outcomes: Overall mortality, disease recurrence, cancer-specific mortality, and postoperative mortality. Categories: Green point (+) = low risk of bias; yellow point (?) = unclear risk of bias; red point (−) = high risk of bias.
Figure 7
Figure 7
Forest plot of the subgroup analysis for 5-year overall mortality.
Figure 8
Figure 8
Forest plot of the subgroup analysis for 5-year disease recurrence.
See this image and copyright information in PMC

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