Laparoscopic vs. open metastatic lateral lymphadenectomy for rectal cancer

Shigeki Yamaguchi, MD, Toshimasa Ishii, MD, Jo Tashiro, MD, Hiroka Kondo, MD, Kiyoka Hara, Masayasu Aikawa, Mitsuo Miyazawa. Saitama medical University Interntional Medical Center

Purpose: Resection of metastatic lateral lymph node for rectal cancer is controversial in western countries. In this study long term results was assessed for lateral lymphadenectomy for lateral node positive patients, also assessed between laparoscopic (lap) and open resection.

Method: Since April 2007 to March 2014, curative resection was performed for 324 lower (extraperitoneal) rectal cancer patients including 25 lateral node positive patients (7.7%). Laparoscopic and open resections with metastatic lateral lymphadenectomy were performed for 6 and 19 patients, respectively. Only 3 patients underwent preoperative chemoradiation to obtain sufficient resection margin.

Results: Mean observation was 1618 days, 5 year cumulative survival was 79.0% and 3 year relapse free survival (RFS) was 58.7%. Recurrence was observed in 12 patients (48%), recurrent sites were; loco-regional 7, lung 5, liver 3, paraaortic 4. According to lateral node positive number, recurrent rates were; 1= 28.6% (4/14), 2= 60% (3/5), 3 or more= 83% (5/6). Mean operative time and blood loss were 327 minutes, 85g in lap and 349 minutes, 587g in open group. Median postoperative hospital stay was 11 in lap and 12 in open. 3 year RFS was 83% in lap and 42% in open (P=0.09).

Conclusion: Lateral lymphadenectomy for node positive rectal cancer patients was effective and laparoscopic resection was feasible for selective patients.

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