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Long-term effects of laparoscopic lateral pelvic lymph node dissection on urinary retention in rectal cancer

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Abstract

Background

The addition of lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery has been reported to increase the incidence of post-operative urinary retention. Here, we assessed the predictive factors and long-term outcomes of urinary retention following laparoscopic LPLND (L-LPLND) with total mesorectal excision (TME) for advanced lower rectal cancer.

Methods

This retrospective single-institutional study reviewed post-operative urinary retention in 71 patients with lower rectal cancer who underwent L-LPLND with TME. Patients with preoperative urinary dysfunction or who underwent unilateral LPLND were excluded. Detailed information regarding patient clinicopathologic characteristics, post-void residual urine volume, and the presence or absence of urinary retention over time was collected from clinical and histopathologic reports and telephone surveys. Urinary retention was defined as residual urine > 100 mL and the need for further treatment.

Results

Post-operative urinary retention was observed in 25/71 patients (35.2%). Multivariate analysis revealed that blood loss ≥ 400 mL [odds ratio (OR) 4.52; 95% confidence interval (CI) 1.24–16.43; p = 0.018] and inferior vesical artery (IVA) resection (OR 8.28; 95% CI 2.46–27.81; p < 0.001) were independently correlated with the incidence of urinary retention. Furthermore, bilateral IVA resection caused urinary retention in more patients than unilateral IVA resection (88.9% vs 47.1%, respectively; p = 0.049). Although urinary retention associated with unilateral IVA resection improved relatively quickly, urinary retention associated with bilateral IVA resection tended to persist over 1 year.

Conclusion

We identified the predictive factors of urinary retention following L-LPLND with TME, including increased blood loss (≥ 400 mL) and IVA resection. Urinary retention associated with unilateral IVA resection improved relatively quickly. L-LPLND with unilateral IVA resection is a feasible and safe procedure to improve oncological curability. However, if oncological curability is guaranteed, bilateral IVA resection should be avoided to prevent irreversible urinary retention.

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Acknowledgements

This work was supported by JSPS KAKENHI Grant Number 20K17621. We thank Melissa Crawford, PhD, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was supported by JSP KAKENHI Grant Number 20K17621.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yoshihiko Sadakari, Kyoko Hisano, Masafumi Sada, Yusuke Mizuuchi, Kinuko Nagayoshi, Hayato Fujita, Shuntaro Nagai, Tatsuya Manabe, Takashi Ueki & Masafumi Nakamura

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  1. Yoshihiko Sadakari
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  2. Kyoko Hisano
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Contributions

YS, KH, SN, and TM are responsible for conception and design. YS, KH, MS, YM, KN, and HF are responsible for acquisition of data. YS, KH, and SN performed analysis and interpretation of data. YS, TU, and MN are responsible for drafting the article or critically revising it for important intellectual content. YS, KH, MS, YM, KN, HF, SN, TM, TU, and MN gave final approval of the version to be published.

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Correspondence to Yoshihiko Sadakari.

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Yoshihiko Sadakari, Kyoko Hisano, Masafumi Sada, Yusuke Mizuuchi, Kinuko Nagayoshi, Hayato Fujita, Shuntaro Nagai, Tatsuya Manabe, Takashi Ueki, and Masafumi Nakamura have no conflicts of interest or financial ties to disclose.

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Sadakari, Y., Hisano, K., Sada, M. et al. Long-term effects of laparoscopic lateral pelvic lymph node dissection on urinary retention in rectal cancer. Surg Endosc 36, 999–1007 (2022). https://doi.org/10.1007/s00464-021-08364-7

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