An update on preservation versus non-preservation of the left colic artery in colorectal cancer surgery: A meta-analysis

In recent years, with the accumulation of statistics and reports from clinical studies, the value of preserving the left colic artery (LCA) during colorectal cancer surgery has been established by multiple studies. This latest meta-analysis aims to provide scientific evidence for evaluating LCA preservation decision-making in such surgeries, clarify the clinical value of the LCA preservation strategy, and offer direct guidance for the individualized selection of surgical approaches. To capture the latest research progress in this field, we searched databases including Web of Science, Cochrane Library, Embase, PubMed, Medline, China National Knowledge Infrastructure (CNKI), Wanfang Data (WFDB), VIP Chinese Science and Technology Periodical Database (VIP), and Chinese Biomedical Literature Database (CBM). We included relevant literature from each database, published from inception to July 2025, with no restrictions. The quality of the retrieved literature was assessed using the Cochrane Collaboration's Risk of Bias tool, the Jadad scoring system, and the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and mean differences (MDs) were used to analyze different types of data, respectively. Meta-analyses were performed with Review Manager Version 5.4 and StataMP 18, selecting the appropriate random- or fixed-effects model. Heterogeneity was assessed using the I 2 statistic, L'Abbe plot, and radial plot, and a sensitivity analysis was conducted on the data. Publication bias was evaluated using funnel plots. The outcome measures of interest included intra- and postoperative indicators (intraoperative blood loss, operation time, postoperative bleeding, length of hospital stay, time to first flatus), complications (anastomotic leakage, surgical site infection, urinary obstruction, intestinal obstruction, defecatory function, etc.), and prognostic indicators (endpoints such as overall survival (OS), disease-free survival (DFS), and recurrence). This meta-analysis included 35 studies, consisting of 8 randomized controlled trials (RCTs), 5 prospective studies, and 22 retrospective studies, with a total of 6518 subjects enrolled; among them, 3150 cases were allocated to the left colic artery (LCA) non-preservation group and 3368 cases to the LCA preservation group. For patients undergoing colorectal cancer surgery, compared with the LCA preservation group, those in the LCA non-preservation group showed statistically significant increases in operative time (MD = −3.01, 95% CI: 4.52 to −1.50, P < 0.0001), intraoperative blood loss(MD = −1.34, 95% CI: 2.39 to −0.29, P = 0.01 < 0.05), postoperative hospital stay (MD = 0.30, 95% CI: 0.07 to 0.52, P = 0.01 < 0.05), time to first flatus (MD = 0.20, 95% CI: 0.03 to 0.37, P < 0.00001) and anastomotic leakage rate (OR = 2.50, 95% CI: 1.86 to 3.36, P < 0.00001), whereas no statistically significant differences were observed between the two groups in terms of incisional infection rate (OR = 1.08, 95% CI: 0.50 to 2.30, P = 0.85 > 0.05), urinary retention rate (OR = 1.27, 95% CI: 0.77 to 2.10, P = 0.36 > 0.05), 5-year overall survival (OS) (OR = 1.02, 95% CI: 0.39 to 2.66, P = 0.97), 5-year disease-free survival (DFS) (OR = 1.07, 95% CI: 0.80 to 1.42, P = 0.66) and 5-year distant metastasis rate (OR = 0.96, 95% CI: 0.72 to 1.28, P = 0.78). This meta-analysis clarifies the clinical value of left colic artery (LCA) preservation versus non-preservation in colorectal cancer surgery, providing core evidence for surgical plan formulation: Preserving the LCA can significantly reduce the risk of anastomotic leakage, especially in high-risk patients with poor nutrition or inadequate intestinal blood supply, without affecting long-term tumor prognosis; although it slightly increases intraoperative operational burden, it promotes postoperative recovery. Non-preservation of the LCA simplifies the procedure, reduces operative time and intraoperative blood loss, but prolongs postoperative recovery, requiring targeted strengthening of postoperative management. There were no significant differences between the two groups in complications such as surgical site infection and urinary retention, as well as long-term tumor outcomes. Only some indicators suggest that LCA preservation may be beneficial to defecatory function, further verifying the clinical controllability of LCA-related surgical procedures. Clinically, the surgical approach should be individually selected based on the patient's risk of anastomotic leakage, tumor location, and the surgeon's technical level. Future studies should focus on the long-term impact of LCA preservation on defecatory function to provide more in-depth research.