Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120, Guangdong, China.
Int J Colorectal Dis. 2020 Jul;35(7):1301-1309. doi: 10.1007/s00384-020-03609-8. Epub 2020 May 2.
Lateral pelvic lymph node (LPLN) dissection represents a technically challenging procedure with a high potential risk of surgical morbidity. The purpose of this study was to compare the technical feasibility, safety, and oncological efficacy of laparoscopic LPLN dissection (LPLD) following total mesorectal excision (TME) with open LPLD for locally advanced low rectal cancer (LALRC).
Between January 2010 and December 2016, consecutive patients with LALRC and swollen LPLNs who underwent laparoscopic or open TME with LPLD at our institution were enrolled in this retrospective observational study. Data regarding patient demographics, perioperative characteristics, and oncological outcomes were analyzed and compared.
A total of 64 patients met the inclusion criteria. Thirty-four patients underwent open procedure, and 30 underwent laparoscopic procedure. The mean blood loss volume was significantly less in the laparoscopic group than in the open group (165 vs. 422 mL; P = 0.012). The mean operative time was not significantly different between the laparoscopic and the open groups (354 ± 91 vs. 315 ± 78 min; P = 0.522). The overall postoperative complication rates were 30.0% and 35.3% for the laparoscopic and open groups (P = 0.428), respectively. Postoperative urinary retention was significantly less in the laparoscopic group than in the open group (14.7 vs. 0%; P = 0.036).The duration of postoperative hospital stay was significantly shorter in the laparoscopic group (8.5 ± 3.8 vs. 13.6 ± 6.5 days; P = 0.025). The numbers of harvested lymph nodes and positive resection margin rates showed no significant differences. Pathological LPLN metastases were confirmed in 10 patients (29.4%) in the open group and 11 (36.7%) in the laparoscopic group (P = 0.537). The median follow-up duration was 41.5 months (range 3-98). The laparoscopic and open groups also showed a similar 3-year overall survival rate (88.2% vs. 85.3%; P = 0.577), relapse-free survival rate (73.3% vs. 67.6%; P = 0.889), and local recurrence rate (3.3 vs. 5.9%; P = 0.653).
Laparoscopic TME with LPLD is technically feasible and safe in selected patients with LALRC and is associated with similar oncological outcomes as open approach.
侧方盆腔淋巴结（LPLN）清扫术是一项技术挑战性较大的手术，具有较高的手术并发症风险。本研究的目的是比较腹腔镜下全直肠系膜切除（TME）后 LPLN 清扫术（LPLD）与开放性 LPLN 清扫术治疗局部晚期低位直肠癌（LALRC）的技术可行性、安全性和肿瘤学疗效。
2010 年 1 月至 2016 年 12 月，连续入组在我院接受腹腔镜或开放性 TME 联合 LPLD 治疗的 LALRC 且 LPLN 肿大的患者，进行了这项回顾性观察性研究。分析并比较了患者人口统计学、围手术期特征和肿瘤学结局数据。
共有 64 名患者符合纳入标准。34 名患者接受了开放性手术，30 名患者接受了腹腔镜手术。腹腔镜组的平均失血量明显少于开放性手术组（165 比 422 毫升；P=0.012）。腹腔镜组和开放性组的平均手术时间无显著差异（354±91 比 315±78 分钟；P=0.522）。腹腔镜组和开放性组的总体术后并发症发生率分别为 30.0%和 35.3%（P=0.428）。腹腔镜组术后尿潴留的发生率明显低于开放性组（14.7%比 0%；P=0.036）。腹腔镜组的术后住院时间明显短于开放性组（8.5±3.8 比 13.6±6.5 天；P=0.025）。两组淋巴结清扫数目和阳性切缘率无显著差异。开放性组 10 例（29.4%）和腹腔镜组 11 例（36.7%）的病理 LPLN 转移（P=0.537）。中位随访时间为 41.5 个月（范围 3-98 个月）。腹腔镜组和开放性组的 3 年总生存率（88.2%比 85.3%；P=0.577）、无复发生存率（73.3%比 67.6%；P=0.889）和局部复发率（3.3%比 5.9%；P=0.653）也相似。
在选择的 LALRC 患者中，腹腔镜 TME 联合 LPLD 是可行且安全的，其肿瘤学结局与开放性手术相似。
