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Laparoscopic versus open selective lateral pelvic lymph node dissection following total mesorectal excision for locally advanced low rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purposes

Lateral pelvic lymph node (LPLN) dissection represents a technically challenging procedure with a high potential risk of surgical morbidity. The purpose of this study was to compare the technical feasibility, safety, and oncological efficacy of laparoscopic LPLN dissection (LPLD) following total mesorectal excision (TME) with open LPLD for locally advanced low rectal cancer (LALRC).

Methods

Between January 2010 and December 2016, consecutive patients with LALRC and swollen LPLNs who underwent laparoscopic or open TME with LPLD at our institution were enrolled in this retrospective observational study. Data regarding patient demographics, perioperative characteristics, and oncological outcomes were analyzed and compared.

Results

A total of 64 patients met the inclusion criteria. Thirty-four patients underwent open procedure, and 30 underwent laparoscopic procedure. The mean blood loss volume was significantly less in the laparoscopic group than in the open group (165 vs. 422 mL; P = 0.012). The mean operative time was not significantly different between the laparoscopic and the open groups (354 ± 91 vs. 315 ± 78 min; P = 0.522). The overall postoperative complication rates were 30.0% and 35.3% for the laparoscopic and open groups (P = 0.428), respectively. Postoperative urinary retention was significantly less in the laparoscopic group than in the open group (14.7 vs. 0%; P = 0.036).The duration of postoperative hospital stay was significantly shorter in the laparoscopic group (8.5 ± 3.8 vs. 13.6 ± 6.5 days; P = 0.025). The numbers of harvested lymph nodes and positive resection margin rates showed no significant differences. Pathological LPLN metastases were confirmed in 10 patients (29.4%) in the open group and 11 (36.7%) in the laparoscopic group (P = 0.537). The median follow-up duration was 41.5 months (range 3–98). The laparoscopic and open groups also showed a similar 3-year overall survival rate (88.2% vs. 85.3%; P = 0.577), relapse-free survival rate (73.3% vs. 67.6%; P = 0.889), and local recurrence rate (3.3 vs. 5.9%; P = 0.653).

Conclusions

Laparoscopic TME with LPLD is technically feasible and safe in selected patients with LALRC and is associated with similar oncological outcomes as open approach.

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Funding

This research was supported by a grant from the National Medical Science Development Programs, The National Health Commission of China (W2015JZC01).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, China

    Bin Yang, Jing Huang, Shengning Zhou, Jianan Tan, Guangyu Zhong, Han Gao & Fanghai Han

Authors
  1. Bin Yang
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  2. Jing Huang
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  3. Shengning Zhou
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  4. Jianan Tan
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  5. Guangyu Zhong
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  6. Han Gao
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  7. Fanghai Han
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Contributions

Fanghai Han and Han Bin Yang contributed to the study conception and design; Bin Yang, Jing Huang, and Han Gao contributed to the acquisition of data; Shengning Zhou, Jianan Tan, and Guangyu Zhong contributed to the analysis and interpretation of data; Bin Yang, Fanghai Han, Jing Huang, and Shengning Zhou contributed to the writing of the manuscript; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Fanghai Han.

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The authors declare that they have no conflicts of interest.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and the institutional review board of Sun Yat-sen Memorial Hospital of Sun Yat-sen University approved the project.

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Written informed consent was obtained from individual or guardian participants included in the study.

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Yang, B., Huang, J., Zhou, S. et al. Laparoscopic versus open selective lateral pelvic lymph node dissection following total mesorectal excision for locally advanced low rectal cancer. Int J Colorectal Dis 35, 1301–1309 (2020). https://doi.org/10.1007/s00384-020-03609-8

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