Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum: comparison of surgical and oncological outcomes with the open technique.

Background: Level of proximal lymphovascular ligation remains controversial in carcinoma rectum. High-tie inferior mesenteric artery (IMA) claims better lymph node clearance; low-tie IMA minimizes autonomic nerve injury (ANI) and ensures vascularity to anastomosis. Objective of this study is to compare postsurgical complications and oncological clearance in laparoscopic rectal resection (LRR) and open rectal resection (ORR) for carcinoma rectum, with low-tie IMA and selective D3 lymphadenectomy.

Methods: Retrospective analysis was done comparing LRR and ORR done with low-tie IMA for carcinoma rectum/rectosigmoid for significant differences (P<0.05) regarding postsurgical complications and histopathology parameters.

Results: A total of 118 patients; 48 in LRR group and 70 in ORR group were studied. They were comparable in age, site of lesion and clinical TNM (cTNM) stage. Comorbidities and symptoms requiring upfront surgery were more among ORR. 75% LRR and 55.3% ORR had neoadjuvant chemoradiation (NACRT). Duration of surgery was longer in LRR. Clavien-Dindo grade >3 was similar in two groups. Histopathology characteristics were also comparable; including specimen length, lymph node yield, length of distal margin and pathologic TNM (pTNM) stage. Selective D3 lymphadenectomy was done in 37.5% LRR and 37.14% ORR. And 4.16% in LRR and 4.28% in ORR were had positive IMA root lymph nodes.

Conclusions: The post-surgical complications and oncological clearance of LRR done with low-tie IMA and selective D3 lymphadenectomy were found equivalent to ORR. Low-tie IMA without routine splenic flexure mobilisation had no technical issues regarding the anastomosis.