D3 lymph node dissection with versus without left colic artery preservation in single-incision laparoscopic surgery for sigmoid and rectosigmoid cancer: a propensity score-matched analysis

Purpose In surgery for colorectal cancer, dissection of the lymph nodes and fatty tissue around the root of the inferior mesenteric artery is important from an oncologic point of view. However, it is debatable whether it is better to preserve or remove the left colic artery (LCA). This study aimed to compare D3 lymphadenectomy with versus without LCA preservation in single-incision laparoscopic surgery for sigmoid and rectosigmoid cancer. Methods: A total of 1138 patients underwent surgery for colorectal cancer between April 2011 and December 2018 at Fukui Prefectural Hospital. This propensity score-matched retrospective study analysed the data of 163 patients: 42 patients with LCA preservation (group A) and 129 without LCA preservation (group B). Clinical and oncological outcomes were compared between the two groups. Results: After propensity score matching, the mean ASA score was slightly lower in group B than in group A. There were no significant differences between groups A and B in surgical outcomes, including the 5-year overall survival rate (80% vs 80%, hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.43–2.86), 5-year disease-free survival rate (76.6% vs 80%, HR 0.82, 95% CI 0.26–2.48), and 5-year cancer-specific survival rate (90% vs 83.3%, HR 1.29, 95% CI 0.34–5.23). Conclusion: There were no significant differences in the short- and long-term outcomes of patients who underwent single-incision laparoscopic surgery with D3 lymphadenectomy with versus without LCA preservation. This suggests that LCA preservation is safe and feasible in single-incision laparoscopic surgery for sigmoid and rectosigmoid colon cancer.