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首页> 外文期刊>Surgical Endoscopy >Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer
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Short-term outcomes of laparoscopic lateral pelvic node dissection for advanced lower rectal cancer

机译：腹腔镜横向盆腔节点剖析的短期结果，用于晚期直肠癌

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Background The laparoscopic magnified visual effects and evolution of the laparoscopic camera system have recently enabled us to observe details in the deep pelvic floor. Indications of laparoscopic surgery for colorectal cancer have been expanded, and laparoscopic (Lap) lateral pelvic node dissection (LLND) has been introduced in some institutions. We investigated the feasibility of Lap LLND in patients with locally advanced rectal cancer (LARC). Methods Lap LLND was performed in 38 patients diagnosed with cT3-4 or cN1-2 cancer during 2014-2018. We retrospectively analyzed their surgical and short-term outcomes. Results Laparoscopic surgery was performed in all patients. cStages II/III/IV were found in 6/31/1 patients, respectively. Among them, 25 patients underwent neoadjuvant chemotherapy without radiotherapy. Lap unilateral LLND was performed in 6 patients and Lap bilateral LLND was performed 32 patients. The number of harvested lymph nodes (LNs) were 4 in the unilateral group and 15 in the bilateral group. Operation time was 531 min, and blood loss was 105 ml. Oral intake has started on postoperative day (POD) 3, and pelvic drain was removed on POD 7. Hospital stay was 18.5 days. Seven patients developed a neurogenic bladder (all Clavien-Dindo grade (CD) II and all occured in the bilateral LLND group), one patient developed abdominal bleeding (CD IIIb) and one patient developed anastomotic leakage (CD IIIb). Pathological results revealed 2/5/16/14/1 patients with pStages 0/I/II/III/IV, respectively. Four patients had histopathologically verified lateral pelvic lymph node metastases. There were no local recurrences after curative surgery (median follow-up 24.2 months). Conclusion Although the median follow-up period is relatively short and further follow-up is necessary, oncologically, especially in the point of local control rate, Lap LLND appears to have acceptable in the treatment of LARC without radiotherapy in experienced centers. Further investigations focusing on indications and the Lap LLND procedural technique are required.
机译：背景腹腔镜放大的视觉效果和腹腔镜摄像系统的发展最近使我们能够观察深盆底的细节。腹腔镜手术治疗结直肠癌的适应证已经扩大，腹腔镜（Lap）侧盆腔淋巴结剥离术（LLND）已经在一些机构引入。我们研究了Lap LLND在局部晚期直肠癌（LARC）患者中的可行性。方法对2014-2018年间诊断为cT3-4或cN1-2癌症的38例患者进行Lap LLND。我们回顾性分析了他们的手术和短期结果。结果所有患者均行腹腔镜手术。分别在6/31/1名患者中发现cStages II/III/IV。其中25例患者接受了新辅助化疗，无需放疗。Lap单侧LLND 6例，Lap双侧LLND 32例。单侧组和双侧组分别有4个和15个淋巴结。手术时间为531分钟，失血量为105毫升。术后第3天（POD）开始口服，第7天移除盆腔引流管。住院时间为18.5天。7名患者出现神经源性膀胱（均为Clavien Dindo分级（CD）II，均发生在双侧LLND组），1名患者出现腹部出血（CD IIIb），1名患者出现吻合口瘘（CD IIIb）。病理结果显示，分别有2/5/16/14/1例患者的pStages为0/I/II/III/IV。四名患者经组织病理学证实有侧盆腔淋巴结转移。治愈性手术后无局部复发（中位随访24.2个月）。结论尽管中位随访期相对较短，需要进一步随访，但在肿瘤学方面，尤其是在局部控制率方面，Lap LLND在经验丰富的中心治疗LARC而不进行放疗时似乎是可以接受的。需要进一步调查，重点是适应症和Lap LLND程序技术。

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