Minimally invasive para‐aortic lymph node dissection in left‐sided colonic and rectal cancer: experience based on a high‐volume centre

Abstract

Aim: There is no established consensus on the optimal surgical approach to para-aortic lymph node (PALN) dissection in patients with colorectal cancer. This study aimed to demonstrate the technical and oncological safety of minimally invasive PALN dissection for left-sided colonic and rectal cancer patients with clinically suspected infrarenal PALN metastasis.Method: One hundered and one patients who underwent primary tumour resection and minimally invasive (laparoscopic n = 92, robotic n = 9) PALN dissection for left-sided colonic and rectal cancer were included. Logistic regression analysis was used to identify risk factors for PALN metastasis. Survival outcomes were evaluated using the Kaplan-Meier (log-rank) method.Results: Para-aortic lymph node metastasis was pathologically confirmed in 23 patients (22.8%). Postoperative complications occurred in 22 patients (21.8%). Pathological N2 stage (OR = 9.337, p = 0.003) and inferior mesenteric artery LN metastasis (OR = 7.499, p = 0.009) were independently associated with PALN metastasis. The median follow-up time was 32 months (range 3-92 months). In all patients, the 5-year overall survival (OS) and progression-free survival (PFS) rates were 76.1% and 69.5%, respectively. The 5-year OS and PFS rates in patients with PALN metastasis were 49.8% and 47.5%, respectively.Patients with PALN metastasis had lower 5-year OS (p = 0.023) and PFS rates (p = 0.035) than those without PALN metastasis. Conclusion:Minimally invasive PALN dissection had acceptable postoperative complications and may be oncologically beneficial in selected patients with clinically suspicious PALN metastasis.

Laparoscopic liver metastasectomy, retroperitoneal lymph node dissection and abdominoperineal resection for rectal cancer

“…Colorectal cancers with liver metastases are common and associated with relatively favourable prognoses 1 . However, retroperitoneal lymph node metastases are less frequently observed and are correlated with poor outcomes 2 . Even though synchronous colorectal cancers and liver metastases are operated upon simultaneously and by minimally invasive approaches, retroperitoneal lymph node dissections are still a regular indication for open operations 3 .…”

“…1 However, retroperitoneal lymph node metastases are less frequently observed and are correlated with poor outcomes. 2 Even though synchronous colorectal cancers and liver metastases are operated upon simultaneously and by minimally invasive approaches, retroperitoneal lymph node dissections are still a regular indication for open operations. 3 The present video aims to demonstrate the feasibility and techniques for simultaneous laparoscopic multi-quadrant surgery for primary colorectal cancers and intra-abdominal metastasis.…”

Laparoscopic Salvage Surgery for Infrarenal Para-aortic Lymph Node Recurrence of Rectal Cancer

“…Infrarenal para-aortic lymphadenectomy can be conducted by a minimally invasive surgery with acceptable postoperative morbidity. 5,8 However, salvage surgery is challenging after left-sided colorectal cancer surgery because surgery for a primary tumor leads to adhesion of the reconstructed mesocolon to the retroperitoneum. During all steps of procedures, care should be taken not to injure the marginal artery of the remnant colon.…”