Initial clinical experience with laparoscopic lateral pelvic lymph node dissection (lymphadenectomy) for advanced low rectal cancer

Tóm tắt

Objective: To assess the feasibility, safe, effectiveness of laparoscopic lateral pelvic lymph node dissection (LPLD) for treatment in low rectal cancer. Subject and method: This was a prospective cohort study of rectal cancers for multidisciplinary treatment with LPLD at Department of Colon and Rectal Surgery, 108 Military Central Hospital between July 2018 and July 2019. Result: Eight patients undergoing LPLD, which were bilateral lymphadenectomy in 3 patients and unilateral lymphadenectomy in 5 patients. There was 4 men and 4 women, with a mean (s.d) age of 56.5 (6.3) years. The median tumour distance from the anal verge was 4.7 ± 1.2cm (100% the tumor was extraperitoneal - between the peritoneal reflection and the anus). Pre-operative stage was 75% T₄; 25% T3, 100% N+. 6 patients underwent preoperative long-course chemoradiation. The mean operation time was 171.2 minutes (range, 140 - 200 minutes), mean operarion blood loss was 88.1ml (range, 35 to 200ml). Pre-operative, postoperative morbidity: Hemorrhage was presented as damaged internal iliac veins in 1 patient, 1 patient had anastomotic stenosis. The mean number of harvested lymph nodes was 10.6. The rate of positive lateral lymph nodes was 12.5%. Postoperative cancer stage was 12.5% T₄, 12.5% T₃, 62.5% T₂, 12.5% T₁, 12.5% N₁. The peri-operative and post-operative results of autonomic nerve preservation were performed by using a standard questionnaies of the International Prostate Symptom Score and International Index of Erectile Function. Conclusion: The LPLD technique is feasible, safety, effective method for treatment in low rectal cancer.