Hajime Morohashi, Yoshiyuki Sakamoto, Takanobu Akashi, Hiroshi Ogaswara, Tetsuya Yoshida, Tetsuya Hasebe, Yuto Mitsuhashi, Kentaro Sato, Takafumi Yachi, Takuya Miura, Kenichi Hakamada. Gastroenterological Surgery, Hirosaki University Japan
Purpose: The standard surgical treatment for lower rectal cancer in our department is total mesorectal excision (TME) + bilateral lateral pelvic lymph node dissection (LPLD). We previously reported on the effectiveness of LPLD in preserving the autonomic nerve using an open approach, but have recently adopted laparoscopic TME + bilateral LPLD to achieve a more precise autonomic nerve preservation. Here we compare the surgical outcomes between patients who underwent laparoscopic LPLD and those who underwent open LPLD to assess the feasibility and oncological safety of laparoscopic LPLD.
Methods: We retrospectively reviewed the clinical records of 250 patients who underwent open LPLD (Group O) and 30 patients who underwent laparoscopic LPLD (Group L). These patients were selected from a total of 844 patients who underwent surgery for rectal cancer at our medical department between January 2000 and August 2016. We compared the clinicopathological features and surgical outcomes between patients from Groups O and L.
Results: Of the 250 patients, 202 were men and 78 were women with a mean age of 64 years. In all Group L patients, the procedures were completed without conversion to open surgery. The mean surgical duration was longer in Group L than in Group O (310 vs. 205 min, p < 0.01). Group L also showed less hemorrhage (91 vs. 625, p < 0.01). The total number of lymph node dissections was 27 in Group O and 26 in Group L. The number of lateral pelvic lymph nodes was 10.4 in Group O and 11.7 in Group L. The number of dissected lymph nodes was not statistically different between the two groups. Postoperative mortality and morbidity rates were 0% and 45%. Postoperative complications of Clavien–Dindo grade II or above were observed in 45% of Group O patients and 18% of Group L patients (p < 0.01). Dysuria was observed in 8% of Group O patients, although temporary dysuria was observed in one Group L patient. Group L had shorter hospital stay than Group O (16.2 vs. 21.4 days, p = 0.03).
Conclusion: Laparoscopic TME + bilateral LPLD can preserve the autonomic nerve, has less blood loss, and enables precise dissection. It is technically feasible, safe, and oncologically acceptable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77887
Program Number: P193
Presentation Session: Poster (Non CME)
Presentation Type: Poster