[评论]腹腔镜直肠癌根治术中肠系膜下静脉结扎位点:一项多中心随机对照研究方案OA

Background The optimal level of ligation of the inferior mesenteric vein(IMV)during rectal cancer surgery remains unclear.Lymph nodes are distributed at the root of the IMV,but whether root ligation and lymphadenectomy significantly increase the number of lymph nodes harvested or improve patient prognosis remains unclear.This multicenter randomized-controlled trial was designed to compare long-term survival and short-term outcomes(surgical complications,lymph node yield,postoperative recovery)between high and low IMV ligation during laparoscopic radical rectal cancer resection.Methods This multicenter randomized-controlled trial will enroll 1,516 patients undergoing laparoscopic-assisted radical resection for rectal cancer.Participants will be recruited and randomized(1∶1)by using a dynamic minimization algorithm to balance covariates,including age,sex,American Society of Anesthesiologists classification,tumor location,body mass index,preoperative clinical stage,and neoadjuvant therapy.Patients will be allocated to either high ligation or low ligation of the IMV.The primary endpoint is 3-year disease-free survival.Discussion The IMV ligation level is a critical yet controversial step in radical rectal cancer resection.High-level evidence is lacking regarding whether high IMV ligation improves rectal cancer prognosis,ne-cessitating robust evidence to determine the optimal ligation level.