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Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer treated with preoperative chemoradiotherapy

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Abstract

Background

Laparoscopic lateral pelvic lymph node dissection (LLND) has been reported to be feasible; however, studies comparing the outcomes of laparoscopic LLND with that of open LLND following preoperative chemoradiotherapy (CRT) are limited.

Methods

Between November 2005 and October 2017, 38 patients with locally advanced rectal cancer underwent total mesorectal excision and LLND following preoperative CRT at Kobe University Hospital. The data of the patients who underwent open LLND (OP group, n = 19) and laparoscopic LLND (LAP group, n = 19) were retrospectively collected and compared.

Results

The operative time was significantly longer in the LAP group compared with that in the OP group. However, the volume of blood loss was significantly higher, and transfusion was more frequently performed in the OP group than in the LAP group. The number of LLNs harvested in the LAP group was significantly higher than that in the OP group. The prevalence of perineal wound infection and bowel obstruction was significantly higher in the OP group than in the LAP group. However, no significant differences were observed between the groups in terms of 5-year overall survival, relapse-free survival, and local recurrence-free survival.

Conclusions

Laparoscopic LLND is feasible and safe for patients with rectal cancer who were treated with preoperative CRT. Compared with open LLND, laparoscopic LLND might have several advantages such as higher yields of dissected LLNs and lower incidences of perineal wound infection and bowel obstruction.

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Fig. 1

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Correspondence to Takeru Matsuda.

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Disclosures

Takeru Matsuda, Hiroshi Hasegawa, Kimihiro Yamashita, Tomoko Tanaka, Masashi Yamamoto, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Yasuo Sumi, Satoshi Suzuki, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

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Matsuda, T., Hasegawa, H., Yamashita, K. et al. Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer treated with preoperative chemoradiotherapy. Surg Endosc 34, 1425–1431 (2020). https://doi.org/10.1007/s00464-019-07224-9

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Keywords

  • LLND
  • Laparoscopic
  • CRT
  • Rectal cancer