Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer
- 1 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 35 (4), 1572-1578
- https://doi.org/10.1007/s00464-020-07534-3
Abstract
Background The laparoscopic magnified visual effects and evolution of the laparoscopic camera system have recently enabled us to observe details in the deep pelvic floor. Indications of laparoscopic surgery for colorectal cancer have been expanded, and laparoscopic (Lap) lateral pelvic node dissection (LLND) has been introduced in some institutions. We investigated the feasibility of Lap LLND in patients with locally advanced rectal cancer (LARC). Methods Lap LLND was performed in 38 patients diagnosed with cT3-4 or cN1-2 cancer during 2014-2018. We retrospectively analyzed their surgical and short-term outcomes. Results Laparoscopic surgery was performed in all patients. cStages II/III/IV were found in 6/31/1 patients, respectively. Among them, 25 patients underwent neoadjuvant chemotherapy without radiotherapy. Lap unilateral LLND was performed in 6 patients and Lap bilateral LLND was performed 32 patients. The number of harvested lymph nodes (LNs) were 4 in the unilateral group and 15 in the bilateral group. Operation time was 531 min, and blood loss was 105 ml. Oral intake has started on postoperative day (POD) 3, and pelvic drain was removed on POD 7. Hospital stay was 18.5 days. Seven patients developed a neurogenic bladder (all Clavien-Dindo grade (CD) II and all occured in the bilateral LLND group), one patient developed abdominal bleeding (CD IIIb) and one patient developed anastomotic leakage (CD IIIb). Pathological results revealed 2/5/16/14/1 patients with pStages 0/I/II/III/IV, respectively. Four patients had histopathologically verified lateral pelvic lymph node metastases. There were no local recurrences after curative surgery (median follow-up 24.2 months). Conclusion Although the median follow-up period is relatively short and further follow-up is necessary, oncologically, especially in the point of local control rate, Lap LLND appears to have acceptable in the treatment of LARC without radiotherapy in experienced centers. Further investigations focusing on indications and the Lap LLND procedural technique are required.This publication has 15 references indexed in Scilit:
- Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive SurgeryAnnals of Coloproctology, 2018
- Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212)Annals of Surgery, 2017
- Neoadjuvant Therapy in Rectal CancerDiseases of the Colon & Rectum, 2011
- Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experienceSurgical Endoscopy, 2011
- Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approachSurgical Endoscopy, 2011
- Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancerBritish Journal of Surgery, 2010
- Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trialThe Lancet Oncology, 2008
- Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group TrialAnnals of Surgery, 2007
- Chemotherapy with Preoperative Radiotherapy in Rectal CancerThe New England Journal of Medicine, 2006
- Preoperative versus Postoperative Chemoradiotherapy for Rectal CancerThe New England Journal of Medicine, 2004