Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
BJS Open. 2022 May 2;6(3). doi: 10.1093/bjsopen/zrac068.
Lateral pelvic lymph node dissection (LPLND) is an option in the treatment of rectal cancer and may reduce local recurrence/improve disease-free survival. Advancements in minimally invasive technology have improved the ability to identify anatomy and neurovascular structures that may help in LPLND. The aim of this retrospective study was to evaluate the technical feasibility and oncological safety of laparoscopic LPLND compared with the open LPLND.
Between July 2010 and July 2019, patients from three tertiary referral hospitals who underwent LPLND with total mesorectal excision for primary rectal cancer were included. Baseline patient characteristics, perioperative outcomes, pathologic results, recurrence, and survival were compared between the laparoscopic and open groups.
There were 126 and 70 patients in the laparoscopic and open groups respectively. The laparoscopic group had less estimated blood loss (100 ml versus 300 ml, P < 0.001) and lower transfusion rate (0.8 per cent versus 10.0 per cent; P = 0.003) but longer operating times (318 min versus 270 min, P = 0.004). The laparoscopic group had fewer wound infections (1.6 per cent versus 10.0 per cent, P = 0.011) and neuropathy (0 per cent versus 4.3 per cent, P = 0.044). Lateral pelvic recurrence rate was 7.6 per cent in the laparoscopic group and 19.6 per cent in the open group (P = 0.053). Recurrence-free survival (72.2 per cent versus 63.5 per cent; P = 0.190) and overall survival (93.3 per cent versus 85.0 per cent; P = 0.118) were not significantly different.
Laparoscopic LPLND was associated with improved perioperative outcomes and non-inferior oncological outcomes.
侧方盆腔淋巴结清扫术（LPLND）是直肠癌治疗的一种选择，可降低局部复发率/改善无病生存率。微创技术的进步提高了识别解剖结构和神经血管结构的能力，这可能有助于 LPLND。本回顾性研究旨在评估腹腔镜 LPLND 与开放 LPLND 的技术可行性和肿瘤安全性。
2010 年 7 月至 2019 年 7 月，纳入在三个三级转诊医院接受腹腔镜全直肠系膜切除术治疗原发性直肠癌的 LPLND 患者。比较腹腔镜组和开放组患者的基线特征、围手术期结果、病理结果、复发和生存情况。
腹腔镜组和开放组分别有 126 例和 70 例患者。腹腔镜组的估计出血量较少（100ml 比 300ml，P<0.001），输血率较低（0.8%比 10.0%；P=0.003），但手术时间较长（318min 比 270min，P=0.004）。腹腔镜组的伤口感染率较低（1.6%比 10.0%，P=0.011），神经病变发生率较低（0%比 4.3%，P=0.044）。腹腔镜组的侧方盆腔复发率为 7.6%，开放组为 19.6%（P=0.053）。无复发生存率（72.2%比 63.5%；P=0.190）和总生存率（93.3%比 85.0%；P=0.118）无显著差异。
腹腔镜 LPLND 具有改善的围手术期结果和非劣效的肿瘤学结果。
