The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study.

Abstract

Introduction Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis. Aim To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer. Material and methods Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed. Results A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100–700 ml). The median lymph node yield was 6 (range: 1–41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I–II complications, no Clavien-Dindo III–IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the “nCRT” group and the “no nCRT” group was not significantly different (p = 0.62) either. There were no perioperative deaths. Conclusions Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

Intracorporeal reinforcing sutures reduce anastomotic leakage in double-stapling anastomosis for laparoscopic rectal surgery.

“…However, this technique cannot be performed for low rectal resection with open surgery due to blind areas, and hence the usefulness of laparoscopy can be demonstrated. Recently, in addition to the use of laparoscopy, the fascia space priority approach has been used to effectively demonstrate the outcomes of laparoscopic lateral lymph node dissection [25].…”

Single-incision versus conventional laparoscopic surgery for rectal cancer: a meta-analysis of clinical and pathological outcomes.

“…Oncologically proper resection is a fundamental principle of rectal cancer surgery, and it includes total mesorectal excision (TME) with proper lymph node dissection. TME quality could be assessed by CRM involvement and the integrity of the TME specimen, which is a key determinant for evaluating the safety of laparoscopic rectal cancer surgery [52,53]. The National Comprehensive Cancer Network (NCCN) guideline recommendations are as follows: to examine a minimum of 12 lymph nodes; to acquire an adequate CRM and an adequate distal margin (1 to 2 cm for distal rectal cancers); and to evaluate the quality of mesorectum for low rectal cancers [54].…”

Urogenital dysfunction in patients after miniinvasive restorative low anterior resection with total mesorectal excision.

“…Moreover, surgical complications and the presence of temporary or definitive stomas could negatively impact sexual functioning. Anastomotic leakage is associated with extensive inflammation, which may cause damage to the nerves and seminal vesicles [35,36]. We excluded all patients with any grade of anastomotic leak and two men with major low anterior resection syndrome (LARS) with postoperative stoma creation.…”