Lateral pelvic lymph node dissection using latero-vesical approach with aspiration procedure for advanced lower rectal cancer.

BACKGROUND/AIMS: The aim of this study was to evaluate the impact of complete dissection of areolar tissue surrounding lymph nodes in lateral pelvic lymphadenectomy on the outcome of advanced rectal cancer at or below the peritoneal reflection.

METHODOLOGY: From 1995 to 2004, lateral pelvic lymph node dissection was performed in 141 consecutive patients with advanced rectal cancer at or below the peritoneal reflection by open surgery in our hospital. They were divided into two groups according to the techniques used for lymph node dissection, i.e. conventional method (CM) and our original method, latero-vesical approach with aspiration procedure (LVA), which eliminates not only lymph nodes but also the tissue surrounding the lymph nodes.

RESULTS: The number of dissected lateral pelvic lymph nodes by LVA was significantly higher than that by CM. In patients without lateral pelvic lymph node metastasis, no significant difference in the outcome was observed between the two groups. On the contrary, among the patients with lateral pelvic lymph node metastasis, five-year survival rates of the group with CM or with LVA was 50% and 70% respectively.

CONCLUSIONS: For patients with lateral pelvic lymph node metastasis, lateral pelvic lymphadenectomy, complete dissection of areolar tissue surrounding lymph nodes, may contribute to improve the prognosis of advanced rectal cancer at, or below, the peritoneal reflection.