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Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer

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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.

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Authors and Affiliations

  1. Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan

    Katsuji Tokuhara, Hidehiko Hishikawa, Terufumi Yoshida, Yosuke Ueyama, Kazuhiko Yoshioka & Mitsugu Sekimoto

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  1. Katsuji Tokuhara
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  2. Hidehiko Hishikawa
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  3. Terufumi Yoshida
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  4. Yosuke Ueyama
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  5. Kazuhiko Yoshioka
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  6. Mitsugu Sekimoto
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Correspondence to Katsuji Tokuhara.

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Katsuji Tokuhara, Hidehiko Hishikawa, Terufumi Yoshida, Yosuke Ueyama, Kazuhiko Yoshioka, and Mitsugu Sekimoto have no conflicts of interest or financial ties to disclose.

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Tokuhara, K., Hishikawa, H., Yoshida, T. et al. Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer. Surg Endosc 35, 1572–1578 (2021). https://doi.org/10.1007/s00464-020-07534-3

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  • DOI: https://doi.org/10.1007/s00464-020-07534-3

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