Mathew Joseph, Kazi Mufaddal, Desouza Ashwin, Saklani Avanish
Department of GI Surgical Oncology and Minimal Access Surgery, HealthCare Global Enterprises Ltd (HCG), Bangalore, India.
Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
Ann Surg Oncol. 2025 Jan;32(1):165-175. doi: 10.1245/s10434-024-16320-7. Epub 2024 Oct 24.
Lateral pelvic node dissection (LPLND) is indicated in the surgical management of clinically significant pelvic lymphadenopathy associated with rectal malignancies. However, procedure-related morbidity, including the incidence and predisposing factors for lymphoceles arising in this setting have not been adequately evaluated.
This retrospective single-institution study included 183 patients with nonmetastatic, lateral node-positive rectal cancer undergoing total mesorectal excision with LPLND between June 2014 and May 2023 to determine the incidence and severity of postoperative complications using the Clavien-Dindo system, with logistic regression performed to model a relationship between lymphocele-development and potentially-predictive variables.
In this cohort, mean age was 45.3 ± 12.81 years, 62.8% were male, and 27.9% had body mass index ≥ 25 kg/m. Median tumor-distance from the verge was 3.0 (interquartile range [IQR] 1.0-5.0) cm. Following radiotherapy in 86.9%, all patients underwent surgery: 30.1% had open resection and 26.2% had bilateral LPLND. Median nodal-yield was 6 (IQR 4-8) per side. Postoperatively, 45.3% developed complications, with 18% considered clinically significant. Lymphoceles, detected in 21.3%, comprised the single-most common sequelae following LPLND, 46.2% arising within 30 days of surgery and 33.3% requiring intervention. On multivariate analyses, obesity (hazard ratio [HR] 2.496; 95% confidence interval [CI] 1.094-5.695), receipt of preoperative radiation (HR 10.026; 95% CI 1.225-82.027), open surgical approach (HR 2.779; 95% CI 1.202-6.425), and number of harvested nodes (HR 1.105; 95% CI 1.026-1.190) were significantly associated with lymphocele-development.
Pelvic lymphoceles and its attendant complications represent the most commonly encountered morbidity following LPLND for rectal cancer, with obesity, neoadjuvant radiotherapy, open surgery, and higher nodal-yield predisposing to their development.
对于与直肠恶性肿瘤相关的具有临床意义的盆腔淋巴结肿大，盆腔侧方淋巴结清扫术（LPLND）适用于其手术治疗。然而，与该手术相关的发病率，包括在此情况下出现淋巴囊肿的发生率和诱发因素，尚未得到充分评估。
这项回顾性单机构研究纳入了2014年6月至2023年5月期间183例非转移性、侧方淋巴结阳性的直肠癌患者，这些患者接受了全直肠系膜切除术加LPLND，以使用Clavien-Dindo系统确定术后并发症的发生率和严重程度，并进行逻辑回归以建立淋巴囊肿形成与潜在预测变量之间的关系。
在该队列中，平均年龄为45.3±12.81岁，62.8%为男性，27.9%的体重指数≥25kg/m²。肿瘤距肛缘的中位数为3.0（四分位间距[IQR]1.0 - 5.0）cm。86.9%的患者接受放疗后均接受了手术：30.1%为开放切除，26.2%为双侧LPLND。每侧淋巴结清扫的中位数为6（IQR 4 - 8）个。术后，45.3%的患者出现并发症，其中18%被认为具有临床意义。淋巴囊肿的发生率为21.3%，是LPLND后最常见的单一后遗症，46.2%在术后30天内出现，33.3%需要干预。多因素分析显示，肥胖（风险比[HR]2.496；95%置信区间[CI]1.094 - 5.695）、术前接受放疗（HR 10.026；95% CI 1.225 - 82.027）、开放手术方式（HR 2.779；95% CI 1.202 - 6.425）以及清扫淋巴结数量（HR 1.105；95% CI 1.026 - 1.190）与淋巴囊肿形成显著相关。
盆腔淋巴囊肿及其相关并发症是直肠癌LPLND后最常见的发病率，肥胖、新辅助放疗、开放手术以及更高的淋巴结清扫数量易导致其发生。
