The clinical effect and oncological results of preserving inferior mesenteric artery during laparoscopic complete mesocolic excision for patients with descending colon cancer: a propensity score-matched analysis

The management of the inferior mesenteric artery (IMA) in descending colon cancer (SCC) surgery remains controversial. The aim of this research is to compare the effect of preserving the IMA on early gastrointestinal function (GIF) recovery and oncological results in laparoscopic complete mesocolic excision (CME) for SCC. This study included 81 patients with SCC who had CME at Xiamen University Attached Zhongshan Hospital between January 2012 and August 2021. A total of 55 patients were assigned to the IMA preservation (IMA-P) group, while 26 patients were included in the IMA ligation (IMA-L) group. We took early GIF recovery and mid-term survival outcomes as the primary endpoints, and surgical results and postoperative complications as the secondary endpoints. A 1:1 propensity score-matched (PSM) methodology was utilized to minimize biases. After PSM, the two groups had 22 patients each. The preliminary study results showed no significant distinctions in the two groups’ early GIF recovery (p = 0.767) or survival results. The estimated 3-year overall survival (OS) rates were 81.0% in the IMA-P group but 75.8% in the IMA-L group (p = 0.615). The IMA-P group’s 3-year disease-free survival (DFS) was 63.6%, while the IMA-L group’s was 72.7% (p = 0.619). However, the IMA-P group demonstrated a lower risk of blood loss (70 ml versus 15 ml, p = 0.048) and incidence of postoperative complications (p = 0.021). Compared with IMA-L, IMA-P had substantially lower risk of blood loss and postoperative complications. In cases where it is technically feasible, IMA-P may be a safer option in CME surgery.