To investigate the clinical application of vascular three-dimensional reconstruction in laparoscopic low anterior resection for rectal cancer with preservation of left colic artery (LCA).

A retrospective cohort study was carried out. Clinical data of 146 patients undergoing laparoscopic rectal cancer surgery with preservation of the LCA in the Cancer Hospital Chinese Academy of Medical Sciences from January 2019 to August 2019 were retrospectively analyzed. All the patients were treated with laparoscopic rectal cancer surgery with preservation of the LCA and had complete operative and postoperative data. Based on the vascular reconstruction or not, seventy-two patients received vascular three-dimensional reconstruction (reconstruction group) and 74 patients did not receive reconstruction (non-reconstruction group). Patient demographics, operative data, postoperative complications, pathological data and postoperative recovery data were compared between the two groups.

A total of 146 patients with rectal cancer eligible for enrollment were included in the study, of which 72 were in the reconstruction group and 74 were in the non-reconstruction group. In the reconstruction group, there were 47 males and 25 females, mean age was (59.75±6.2) years old, mean body mass index was (24.1±2.2) kg/m². In the non-reconstruction group, there were 51 males and 23 females, mean age was (58.77±6.1) years old, mean body mass index was (23.6±2.7) kg/m². There was no statistically significant difference in the baseline data between the two groups (P＞0.05). In terms of vascular type of IMA, there were 35 cases for type I, 25 cases for type Ⅱ, 11cases for type Ⅲ and 1 case for type Ⅳ in the reconstruction group and 37 cases for type I, 24 cases for type Ⅱ, 12 cases for type Ⅲ and 1 case for type Ⅳ in the non-reconstruction group. There was no statistically significant difference in the vascular type between the two groups (P＞0.05). The operation time was (162.2±10.8) min in the reconstruction group and (197.9±19.1) min in the non-reconstruction group. Compared with the non-reconstruction group, the operation time was shortened in the reconstruction group, and the difference was statistically significant (t=-13.840, P＜0.05). Intraoperative blood loss was (30.4±20.0) mL in the reconstruction group and (61.2±26.4) mL in the non-reconstruction group. The blood loss in the reconstruction group was less, and the difference was statistically significant (t=-7.930, P<0.05). There were no statistically significant differences between the reconstruction group and non-reconstruction group, with regard to anastomotic leakage (1 case, 1.4% vs. 1 case, 1.4%, P=0.984), anastomotic bleeding (2 cases, 2.8% vs. 3 cases, 4.1%, P=0.672), postoperative hospitalization (6.8±0.7 d vs.7.0±0.7 d, P=0.141) and postoperative pathological outcomes (P＞0.05).

Our study suggested that preoperative vascular three-dimensional reconstruction can reduce the operative time and blood loss in laparoscopic rectal cancer surgery with preservation of the LCA. Preoperative vascular three-dimensional reconstruction, which can provide reference for the operation, is therefore recommended for laparoscopic rectal cancer surgery with LCA preservation in rectal cancer surgery.