Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Surg Endosc. 2023 Jul;37(7):5256-5264. doi: 10.1007/s00464-023-10012-1. Epub 2023 Mar 27.
An optimal surgical approach to lateral lymph node dissection (LLND) remains controversial. With the recent popularity of transanal total mesorectal excision, a two-team procedure combining the transabdominal and transanal approaches was established as a novel approach to LLND. This study aimed to clarify the safety and feasibility of two-team LLND (2team-LLND) and compare its short-term outcomes with those of conventional transabdominal LLND (Conv-LLND).
Between April 2013 and March 2020, 463 patients diagnosed with primary locally advanced rectal cancer underwent a transanal total mesorectal excision; among them, 93 patients who underwent bilateral prophylactic LLND were included in this single-center, retrospective study. Among these patients, 50 and 43 patients underwent Conv-LLND (the Conv-LLND group) and 2team-LLND (the 2team-LLND group), respectively. The short-term outcomes, including the operation time, blood loss volume, number of complications, and number of harvested lymph nodes, were compared between the two groups.
The intraoperative and postoperative complications in the 2team-LLND group were equivalent to those in the Conv-LLND group; furthermore, the incidence of postoperative urinary retention in the 2team-LLND group was acceptably low (9%). Compared with the Conv-LLND group, the 2team-LLND group had a significantly shorter operation time (P = 0.003), lower median blood loss (P = 0.02), and higher number of harvested lateral lymph nodes (P = 0.0005).
The intraoperative and postoperative complications of 2team-LLND were comparable with those of Conv-LLND. Thus, 2team-LLND was safe and feasible for advanced lower rectal cancer. Moreover, it was superior to Conv-LLND in terms of the operation time, blood loss volume, and number of harvested lateral lymph nodes. Therefore, it can be a promising LLND approach.
侧方淋巴结清扫术（LLND）的最佳手术入路仍存在争议。随着经肛门全直肠系膜切除术的普及，一种结合经腹和经肛门入路的双团队手术方式被确立为一种新的 LLND 方法。本研究旨在阐明双团队 LLND（2team-LLND）的安全性和可行性，并将其短期结果与传统经腹 LLND（Conv-LLND）的结果进行比较。
2013 年 4 月至 2020 年 3 月，463 例原发性局部进展期直肠癌患者接受了经肛门全直肠系膜切除术；其中，93 例接受双侧预防性 LLND 的患者被纳入本单中心回顾性研究。这些患者中，50 例和 43 例患者分别接受了 Conv-LLND（Conv-LLND 组）和 2team-LLND（2team-LLND 组）。比较两组的手术时间、出血量、并发症数量和清扫的淋巴结数量等短期结果。
2team-LLND 组的术中及术后并发症与 Conv-LLND 组相当，且 2team-LLND 组术后尿潴留的发生率较低（9%）。与 Conv-LLND 组相比，2team-LLND 组的手术时间显著缩短（P=0.003），中位出血量减少（P=0.02），清扫的侧方淋巴结数量更多（P=0.0005）。
2team-LLND 的术中及术后并发症与 Conv-LLND 相当，因此，2team-LLND 对于中低位进展期直肠癌是安全可行的。而且，2team-LLND 在手术时间、出血量和清扫的侧方淋巴结数量方面优于 Conv-LLND。因此，它可能是一种有前途的 LLND 方法。
