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High ligation of the inferior mesenteric artery and anastomotic leakage in anterior resection for rectal cancer: a systematic review and meta‐analysis of randomized controlled trial studies
Author(s) -
Kong Meng,
Chen Hongyuan,
Xin Yingying,
Jiang Yugang,
Han Yue,
Sheng Hongguang
Publication year - 2021
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15419
Subject(s) - medicine , randomized controlled trial , meta analysis , inferior mesenteric artery , odds ratio , colorectal cancer , anastomosis , surgery , ligation , hazard ratio , confidence interval , cancer
Aim Surgeons have concerns whether high ligation (HL) of the inferior mesenteric artery (IMA) increases the incidence of anastomotic leakage (AL). This meta‐analysis aimed to evaluate the influence of HL of the IMA on AL compared with low ligation (LL). Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched. Randomized controlled trial studies that compared HL with LL of the IMA in anterior resection for rectal cancer and reported AL outcomes were eligible for inclusion. The odds ratios and mean differences were analysed by a random‐effects model. Trial sequential analysis was performed to minimize the risk of random errors. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence for outcomes. Results Of the 531 records screened, five randomized controlled trials with 779 patients were selected for analysis. The pooled incidence of AL was 12.1% (95% Cl 7.77–18.26) in the HL group and 9.7% (95% Cl 5.79–15.82) in the LL group (OR 1.20, 95% CI 0.77–1.87, P = 0.42). In trial sequential analysis, the cumulative Z ‐score curve exceeded the futility boundary, although the required information size of 1060 had not been reached. The quality of evidence was judged to be high according to the GRADE approach. Conclusions This meta‐analysis shows that HL of the IMA does not increase the incidence of AL in anterior resection for rectal cancer.