Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: initial clinical experiences with prophylactic dissection

Shinsaku Obara, Fumikazu Koyama, Tadashi Nakagawa, Shinji Nakamura, Takeshi Ueda, Naoto Nishigori, Takashi Inoue, Keijiro Kawasaki, Takayuki Nakamoto, Hisao Fujii, Yoshiyuki Nakajima
Gan to Kagaku Ryoho. Cancer & Chemotherapy 2012, 39 (12): 2173-5

AIM: To evaluate the technical feasibility of laparoscopic lateral pelvic lymph node dissection (LPLD) following total mesorectal excision (TME) as prophylaxis for patients with advanced lower rectal cancer but no radiologic evidence of lymph node involvement.

PATIENTS AND METHODS: TME was performed on 30 patients with cT3N1-2M0 lower rectal cancer. LPLD was performed by laparoscopic surgery in 12 patients (LAP group),and open surgery in 18 patients (Open group). Statistical analysis was used to compare the number of harvested lymph nodes, operative time, operative blood loss, transfusion rate, and volume of transfusion between the groups.

RESULTS: No significant difference was observed in the number of harvested lymph nodes. Operative time was significantly longer in the LAP group; however, operative blood loss, transfusion rate, and volume of transfusion were significantly lower in the LAP group.

CONCLUSION: Laparoscopic LPLD, when performed by a well-trained laparoscopic team, is safe and feasible in some selected lower rectal cancer patients. This approach has the potential to achieve oncologic lymph node clearance equivalent to open surgical LPLD, and to overcome the cited disadvantages of LPLD, which include greater operative blood loss and urinary dysfunction.

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