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Initial experience with the transanal approach for lateral pelvic lymph node dissection in rectal cancer

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Abstract

Background

The efficacy and safety of transanal lateral pelvic lymph node dissection (TaLPLND) in rectal cancer has not yet been clarified. The aim of the present study was to evaluate the short-term results as an initial experience of TaLPLND.

Methods

This retrospective study included patients with middle to lower rectal cancer who underwent TaLPLND from July 2018 to July 2021. Our institutions targeted lymph nodes in the internal iliac area and the obturator area for lateral pelvic lymph node dissection (LPLND).

Results

A total of 30 consecutive patients with rectal cancer were included in this analysis. The median age was 60 years (range, 36–83 years), and the male–female ratio was 2:1. The median operative time was 362 min (IQR, 283–661 min), and the median intraoperative blood loss was 74 ml (IQR, 5–500 ml). Intraoperative blood transfusion was required in one case. No cases required conversion to laparotomy. TaLPLND was performed bilaterally in 13 patients (43.3%). Five patients (16.7%) underwent LPLND with combined resection of the internal iliac vessels. The median distance of the distal margin from the anal verge was 20 mm. The pathological radial margin (pRM) was positive in one case, and the negative pRM rate was 96.7%. Short-term postoperative complications (Clavien–Dindo classification grade ≥ II) were observed in nine cases (30.0%). There were no cases of reoperation or mortality. The median number of harvested lateral pelvic lymph nodes was 11 (range, 3–28). On pathological examination, lateral pelvic lymph nodes were positive for metastasis in seven cases (23.3%).

Conclusions

TaLPLND appeared to be beneficial from an oncological point of view because it was close to the upstream lymphatic drainage from the tumor. The short-term outcomes of this initial experience indicate that this novel approach is feasible.

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Data availability

The datasets generated during and/or analyzed during the current study are not available.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-Ku, Yokohama, Japan

    H. Ohya, K. Nakagawa, M. Ozawa, A. Ishibe & I. Endo

  2. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, YokohamaYokohama, 232-0024, Japan

    J. Watanabe, K. Chida, K. Goto & Y. Suwa

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

    H. Suwa

Authors
  1. H. Ohya
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  2. J. Watanabe
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  3. K. Chida
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  4. K. Goto
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  5. Y. Suwa
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  6. K. Nakagawa
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  7. H. Suwa
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  8. M. Ozawa
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  9. A. Ishibe
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  10. I. Endo
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Contributions

H.O.: making the concept and plan of this study, collection of data, data analysis and interpretation, manuscript writing, and final approval. J.W.: making the concept and plan of this study, collection of data, data analysis and interpretation, manuscript writing, and final approval. K.C.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. K.G.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. Y.S.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. K.N.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. H.S.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. M.O.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. A.I.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval. I.E.: making the concept and plan of this study, collection of data, critical revision for important intellectual content, and final approval.

Corresponding author

Correspondence to J. Watanabe.

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Conflict of interest

Dr. Jun Watanabe reports receiving honoraria for lectures from Johnson and Johnson, Medtronic, and Eli Lilly and receiving research funding from Medtronic, AMCO, and TERUMO outside the submitted work. Drs. Hiroki Ohya, Keigo Chida, Kouki Goto, Yusuke Suwa, Kazuya Nakagawa, Hirokazu Suwa, Mayumi Ozawa, Atsushi Ishibe, and Itaru Endo declare no conflicts of interest in association with the present study.

Ethical approval

This study protocol was approved by the Ethical Advisory Committee of Yokohama City University (B191200061) and the institutional review board of each participating hospital and conformed to the provisions of the Declaration of Helsinki.

Consent to participate

Due to the study’s retrospective nature, written informed consent was not obtained. Therefore, we used the opt-out approach to disclose the study information. Participants were provided with information about this project and were able to decline participation voluntarily.

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Ohya, H., Watanabe, J., Chida, K. et al. Initial experience with the transanal approach for lateral pelvic lymph node dissection in rectal cancer. Tech Coloproctol 27, 685–691 (2023). https://doi.org/10.1007/s10151-023-02763-9

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  • DOI: https://doi.org/10.1007/s10151-023-02763-9

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