Association between left colic artery preservation and surgical outcomes after laparoscopic radical resection for rectal cancer: a propensity score-matched analysis.

To evaluate the association between left colic artery (LCA) preservation during laparoscopic rectal cancer resection and the incidence of anastomotic leakage (AL) and perioperative outcomes. Clinical data were retrospectively collected from patients who underwent laparoscopic rectal cancer resection at the First Affiliated Hospital of Nanjing Medical University between July 2020 and February 2023. Patients were divided into an LCA-preservation group and a non-preservation group according to whether the left colic artery (LCA) was preserved intraoperatively. A 1:1 propensity score matching analysis was performed to balance baseline covariates, including sex, age, body mass index, comorbidities, American Society of Anesthesiologists classification, TNM stage, tumor differentiation, distance from the anal verge, and tumor size. Postoperative outcomes were subsequently compared between the two groups. A total of 500 patients were included, comprising 341 patients in the LCA-preservation group and 159 in the non-preservation group. Before matching, patients in the non-preservation group had more advanced TNM stages and a higher incidence of AL than those in the LCA-preservation group. After propensity score matching, baseline characteristics were well balanced between the two groups. The incidence of AL remained significantly higher in the non-preservation group than in the LCA-preservation group (P = 0.038). Operative time was significantly longer in the LCA-preservation group (P = 0.026), whereas no significant differences were observed in intraoperative blood loss, drainage volume on postoperative day 1, or postoperative length of hospital stay. In laparoscopic rectal cancer resection, LCA preservation was associated with a lower incidence of anastomotic leakage, potentially through the maintenance of proximal bowel perfusion. Although this technique may prolong operative time, it does not appear to increase other major perioperative adverse outcomes, supporting its potential clinical value.