Skip to main content

Advertisement

SpringerLink
Log in

Short- and long-term outcomes of laparoscopic versus open lateral lymph node dissection for locally advanced middle/lower rectal cancer using a propensity score-matched analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

There are few reports on large-scale trials for the long-term outcomes regarding laparoscopic lateral lymph node dissection (LLND). We evaluated the short- and long-term outcomes of laparoscopic versus open LLND for locally advanced middle/lower rectal cancer using a propensity score-matched analysis.

Methods

From January 2005 to December 2016, consecutive clinical stage II to III middle/lower rectal cancer patients who underwent total mesorectal excision (TME) plus LLND were retrospectively collected at three institutions. Laparoscopic LLND was compared with open LLND for the surgical and oncological outcomes, including the long-term survival, using a propensity score-matched analysis.

Results

A total of 325 patients were collected. There were 142 patients who underwent open TME plus LLND (open group) and 183 patients who underwent laparoscopic TME plus LLND (laparoscopic group). A total of 93 patients each were matched to each group. Compared to the open group, the laparoscopic group had a significantly longer operative time (327 vs. 377 min; p = 0.002) but significantly less blood loss (540 vs. 50 ml; p < 0.001), fewer Clavian-Dindo grade ≥ 2 postoperative complications (49.5% vs. 34.4%; p = 0.037) and shorter postoperative hospital stay (18 vs. 14 days; p = 0.008). Furthermore, the rate of urinary retention was significantly lower in the laparoscopic group than in the open group (16.1% vs. 6.5%; p = 0.037). The estimated 3-year overall survival, relapse-free survival, and cumulative incidence of local recurrence were 91.4%, 73.1%, and 3.4% in the open group and 90.3%, 74.2%, and 4.3% in the laparoscopic group (p = 0.879, 0.893, 0.999), respectively.

Conclusions

This study showed that laparoscopic LLND had advantages over an open approach, such as less blood loss, fewer postoperative complications, and a shorter postoperative hospital stay, and the oncologic outcomes were similar to the open approach. Laparoscopic LLND could be a viable standard approach to LLND for advanced middle/lower rectal cancer surgery.

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
Fig. 3

Similar content being viewed by others

References

  1. Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354

    Article  CAS  Google Scholar 

  2. Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315

    Article  CAS  Google Scholar 

  3. Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672

    Article  Google Scholar 

  4. Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncol Funct Outcome Cancer 78:1871–1880

    CAS  Google Scholar 

  5. Takahashi T, Ueno M, Azekura K, Ohta H (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43:S59–68

    Article  CAS  Google Scholar 

  6. Kanemitsu Y, Komori K, Shida D, Ochiai H, Tsukamoto S, Kinoshita T, Moriya Y (2017) Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND. Surgery 162:303–314

    Article  Google Scholar 

  7. Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg 383:409–415

    Article  CAS  Google Scholar 

  8. Ueno H, Mochizuki H, Hashiguchi Y, Hase K (2001) Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 234:190–197

    Article  CAS  Google Scholar 

  9. Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763

    Article  CAS  Google Scholar 

  10. Ozawa H, Kotake K, Hosaka M, Hirata A, Sugihara K (2016) Impact of lateral pelvic lymph node dissection on the survival of patients with T3 and T4 low rectal cancer. World J Surg 40:1492–1499

    Article  Google Scholar 

  11. Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hanai T, Hasumi A (2001) Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer. J Am Coll Surg 193:579–584

    Article  CAS  Google Scholar 

  12. Yang B, Huang J, Zhou S, Tan J, Zhong G, Gao H, Han F (2020) Laparoscopic versus open selective lateral pelvic lymph node dissection following total mesorectal excision for locally advanced low rectal cancer. Int J Colorectal Dis. https://doi.org/10.1007/s00384-020-03609-8

    Article  PubMed  Google Scholar 

  13. Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kunisaki C, Endo I (2020) Autonomic nerve-preserving lymph node dissection for lateral pelvic lymph node metastasis of the pelvic floor using the transanal approach. Dis Colon Rectum 63:113–114

    Article  Google Scholar 

  14. Tokuhara K, Hishikawa H, Yoshida T, Ueyama Y, Yoshioka K, Sekimoto M (2020) Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer. Surg Endosc 7:9

    Google Scholar 

  15. Matsuda T, Hasegawa H, Yamashita K, Tanaka T, Yamamoto M, Kanaji S, Oshikiri T, Nakamura T, Sumi Y, Suzuki S, Kakeji Y (2020) Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer treated with preoperative chemoradiotherapy. Surg Endosc 34:1425–1431

    Article  Google Scholar 

  16. Yamaguchi T, Konishi T, Kinugasa Y, Yamamoto S, Akiyoshi T, Okamura R, Ito M, Nishimura Y, Shiozawa M, Yamaguchi S, Hida K, Sakai Y, Watanabe M (2017) Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: a subgroup analysis of a large Multicenter Cohort Study in Japan. Dis Colon Rectum 60:954–964

    Article  Google Scholar 

  17. Mori T, Kimura T, Kitajima M (2010) Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol 19:18–23

    Article  Google Scholar 

  18. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K, Japanese Society for Cancer of the C, Rectum (2020) Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42

    Article  Google Scholar 

  19. Ouyang M, Liao T, Lu Y, Deng L, Luo Z, Wu J, Ju Y, Yao X (2019) Laparoscopic versus open surgery in lateral lymph node dissection for advanced rectal cancer: a meta-analysis. Gastroenterol Res Pract 2019:7689082

    Article  Google Scholar 

  20. Edge SB, Compton CC (2010) The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  Google Scholar 

  21. Akiyoshi T, Matsueda K, Hiratsuka M, Unno T, Nagata J, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M (2015) Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative chemoradiotherapy in patients with advanced low-rectal cancer. Ann Surg Oncol 22(Suppl 3):S614–620

    Article  Google Scholar 

  22. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Murata K, Akagi Y, Takiguchi N, Saida Y, Nakamura K, Fukuda H, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg 266:201–207

    Article  Google Scholar 

  23. Tsukamoto S, Fujita S, Ota M, Mizusawa J, Shida D, Kanemitsu Y, Ito M, Shiomi A, Komori K, Ohue M, Akazai Y, Shiozawa M, Yamaguchi T, Bando H, Tsuchida A, Okamura S, Akagi Y, Takiguchi N, Saida Y, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G (2020) Long-term follow-up of the randomized trial of mesorectal excision with or without lateral lymph node dissection in rectal cancer (JCOG0212). Br J Surg 107:586–594

    Article  CAS  Google Scholar 

  24. Oh HK, Kang SB, Lee SM, Lee SY, Ihn MH, Kim DW, Park JH, Kim YH, Lee KH, Kim JS, Kim JW, Kim JH, Chang TY, Park SC, Sohn DK, Oh JH, Park JW, Ryoo SB, Jeong SY, Park KJ (2014) Neoadjuvant chemoradiotherapy affects the indications for lateral pelvic node dissection in mid/low rectal cancer with clinically suspected lateral node involvement: a multicenter retrospective cohort study. Ann Surg Oncol 21:2280–2287

    Article  Google Scholar 

  25. Ogura A, Konishi T, Cunningham C, Garcia-Aguilar J, Iversen H, Toda S, Lee IK, Lee HX, Uehara K, Lee P, Putter H, van de Velde CJH, Beets GL, Rutten HJT, Kusters M, Lateral Node Study C (2019) Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol 37:33–43

    Article  CAS  Google Scholar 

  26. Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, Ohue M, Fujii S, Shiozawa M, Yamaguchi T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G (2012) Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 13:616–621

    Article  Google Scholar 

  27. Ogura A, Akiyoshi T, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M, Kuroyanagi H (2017) Feasibility of laparoscopic total mesorectal excision with extended lateral pelvic lymph node dissection for advanced lower rectal cancer after preoperative chemoradiotherapy. World J Surg 41:868–875

    Article  Google Scholar 

  28. Nagayoshi K, Ueki T, Manabe T, Moriyama T, Yanai K, Oda Y, Tanaka M (2016) Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach. Surg Endosc 30:1938–1947

    Article  Google Scholar 

  29. Ito M, Kobayashi A, Fujita S, Mizusawa J, Kanemitsu Y, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G (2018) Urinary dysfunction after rectal cancer surgery: Results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 44:463–468

    Article  Google Scholar 

  30. Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y, Akazai Y, Ota M, Ohue M, Komori K, Shiozawa M, Yamaguchi T, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G (2016) Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 42:1851–1858

    Article  CAS  Google Scholar 

  31. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  Google Scholar 

  32. Tepper JE, O'Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd, Cummings B, Gunderson L, Macdonald JS, Mayer RJ (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Jun Watanabe, Yusuke Suwa, Mitsuyoshi Ota & Chikara Kunisaki

  2. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Atsushi Ishibe, Mayumi Ozawa, Kazuya Nakagawa & Itaru Endo

  3. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan

    Hirokazu Suwa

Authors
  1. Jun Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Ishibe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Suwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mayumi Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuya Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirokazu Suwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsuyoshi Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chikara Kunisaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Itaru Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Watanabe.

Ethics declarations

Disclosures

Drs. Jun Watanabe, Atsushi Ishibe, Yusuke Suwa, Mayumi Ozawa, Kazuya Nakagawa, Hirokazu Suwa, Mitsuyoshi Ota, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 100 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watanabe, J., Ishibe, A., Suwa, Y. et al. Short- and long-term outcomes of laparoscopic versus open lateral lymph node dissection for locally advanced middle/lower rectal cancer using a propensity score-matched analysis. Surg Endosc 35, 4427–4435 (2021). https://doi.org/10.1007/s00464-020-07943-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07943-4

Keywords

Search

Navigation