Skip to main content

Advertisement

SpringerLink
Log in

Technical Feasibility of Laparoscopic Lateral Pelvic Lymph Node Dissection for Patients with Low Rectal Cancer after Concurrent Chemoradiation Therapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Aim

To test the technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with clinically positive lateral node(s) after preoperative concurrent chemoradiation therapy for lower rectal cancer.

Methods

The operation procedures are detailed in the attached video.

Results

Forty-five procedures of laparoscopic lateral pelvic lymphadenectomy were performed in 34 patients, with dissection over bilateral lateral node foci in 11 patients and dissection over unilateral lateral node station in 23. There were four procedures in which the metastatic node was very close to or even encased the adjacent iliac vessel and therefore the lymphadenectomy was done with a surgical margin of less than 1 mm. The median (range) number of lymph nodes harvested in each lateral station was 6 (2–14). Lympho-adipose tissues from 32 (71.1%, 32/45) lateral node dissections were confirmed by histopathology to harbor metastatic adenocarcinoma. For unilateral lateral pelvic lymph node dissection, median (range) blood loss was 44 (20–240) ml and median (range) operation time was 58 (42–94) min. There was one (2.9%) operative mortality and seven (20.6%) postoperative complications. Postoperatively, most patients presented with mild postoperative pain and quick convalescence. During follow-up (mean 24 months), nine patients (27.3%) developed recurrent disease. Remarkably, all four patients with surgical margin less than 1 mm developed cancer recurrence.

Conclusions

Laparoscopic lateral pelvic lymphadenectomy is technically feasible for some selected patients. To date, laparoscopic approach is still underdeveloped to treat the complex clinical condition in which the metastatic node involves the iliac vessel and combined resection of the vessel is required to obtain sufficient margin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Akasu T, Moriya Y. Abdominopelvic lymphadenectomy with automic nerve perservation for carcinoma of the rectum: Japanese experience. In: Wanebo HJ, editors. Surgery for Gastroinestinal cancer: a multidisciplinary approach. Philadelphia: Lippicott-Raven; 1997. p. 667–80.

  2. Ueno M, Oya M, Azekura K, et al. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.

    Article  CAS  PubMed  Google Scholar 

  3. Liang JT, Lai HS, Lee PH. Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol. 2007;14:1285–7.

    Article  PubMed  Google Scholar 

  4. Liang JT, Huang KC, Lai HS, et al. Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol. 2007;14:1980–90.

    Article  PubMed  Google Scholar 

  5. Liang JT, Lai HS, Lee PH. Laparoscopic abdominoanal pull-through procedure for male patients with lower rectal cancer after chemoradiation therapy. Dis Colon Rectum. 2006;49:259–60.

    Article  PubMed  Google Scholar 

  6. Uyama I, Sugioka A, Matsui H, et al. Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer. J Am Coll Surg. 2001;193:579–84.

    Article  CAS  PubMed  Google Scholar 

  7. Ueno H, Mochizuki H, Hashiguchi Y, et al. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg. 2001;234:190–7.

    Article  CAS  PubMed  Google Scholar 

  8. Kusters M, Beets GL, van de Velde CJ, et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249:229–35.

    Article  PubMed  Google Scholar 

  9. Yano H, Moran BJ. The incidence of lateral pelvic side-wall nodal involvement in low rectal cancer may be similar in Japan and the West. Br J Surg. 2008;95:33–49.

    Article  CAS  PubMed  Google Scholar 

  10. Georgiou P, Tan E, Gouvas N, et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol. 2009;10:1053–62.

    Article  PubMed  Google Scholar 

  11. Ueno M, Oya M, Azekura K, et al. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92:756–63.

    Article  CAS  PubMed  Google Scholar 

  12. Moriya Y. Importance of lymphatic spread. In: Soreide O, Norstein J, editors. Rectal cancer surgery: optimisation standardisation Documentation. Berlin: Springer; 1997. p. 153–64.

  13. Takahashi T, Ueno M, Azekura K, Ota H. The lymphtic soread of rectal cancer and the effect of dissection: Japanese contribution and experience. In: Soreide O, Norstein J, editors. Rectal cancer surgery: optimisation standardisation documentation. Berlin: Springer; 1997. p. 165–80.

  14. Kim JC, Takahashi K, Yu CS, et al. Comparative outcome between Chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007;246:754–62.

    Article  PubMed  Google Scholar 

  15. Watanabe T, Tsurita G, Muto T, et al. Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery. 2002;132:27–33.

    Article  PubMed  Google Scholar 

  16. Wichmann MW, Müller C, Meyer G, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg. 2002;137:206–10.

    Article  PubMed  Google Scholar 

  17. Kim YW, Kim NK, Min BS, et al. The prognostic impact of the number of lymph nodes retrieved after neoadjuvant chemoradiotherapy with mesorectal excision for rectal cancer. J Surg Oncol. 2009;100:1–7.

    Article  CAS  PubMed  Google Scholar 

  18. Wanebo HJ, Turk PS. Abdominosacral resection for recurrent rectal cancer. In: Beuer JJ, Gorfine SR, Kreel 1, Gelernt IM, Rubin P, eds. Colorectal surgery illustrated: a focused approach, St. Louis: Mosby Year Book; 1993. p. 248.

  19. Bernstein1 TE, Endreseth BH, P Romundstad, et al. Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg. 2009;96:1348–57.

    Google Scholar 

Download references

Conflict of interest

We certified that the authors of this article do not have commercial associations that might pose a conflict of interest in connection with the submitted article.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC

    Jin-Tung Liang MD, PhD

Authors
  1. Jin-Tung Liang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin-Tung Liang MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MPG 48708 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liang, JT. Technical Feasibility of Laparoscopic Lateral Pelvic Lymph Node Dissection for Patients with Low Rectal Cancer after Concurrent Chemoradiation Therapy. Ann Surg Oncol 18, 153–159 (2011). https://doi.org/10.1245/s10434-010-1238-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1238-2

Keywords

Search

Navigation