Momoko Ichihara, Masataka Ikeda, Mamoru Uemura, Masakazu Miyake, Takuya Hamakawa, Sakae Maeda, Naoki Hama, Kazuhiro Nishikawa, Atsushi Miyamoto, Michihiko Miyazaki, Motohiro Hirao, Shoji Nakamori, Mitsugu Sekimoto. National Hospital Organization Osaka National Hospital
Backgrounds: Lateral pelvic lymph node (LPLN) metastasis has been considered as distant metastasis and often treated by systemic chemotherapy. However, complete radical resection of LPLN metastasis can achieve cure in some patients. As safety and efficacy of radical LPLN resection have not been well elucidated, this study evaluated the feasibility of laparoscopic radical LPLN resection comparing with the conventional open approach and oncological outcome between the patients with and without re-recurrence after LPLN resection.
Patients and methods: We retrospectively reviewed the clinical records of 17 patients who underwent radical resection for metastasis of LPLN after curative rectal surgery between July 2012 and August 2016 in Osaka National Hospital.There were 4 open surgeries and 13 laparoscopic surgeries.Operative factors (time, blood loss, post-operative complications, CRP elevation, and post-operative hospital stay) were compared between the open and laparoscopic surgeries. Sixteen patients had pre-operative chemoradiation and/or radiation therapy. Oncological outcomes were assessed in terms of response of preoperativeadjuvant therapy. Responders were defined as the pathological tumor regression greater than 67% of all tumor areas.
Results: There were no mortalities in all 17 patients, and no conversion to open surgery in the laparoscopic group.Median blood loss (60 vs 1075 ml, P=0.03), CRP elevation on post-operative day 3 (5.95 vs 18.09 mg/dl, P=0.014), and post-operative hospital stay (17.0 vs 32.5 days, P=0.023) were significantly smaller and shorter in the laparoscopic group. The median operation time (316 vs 311 min, P=0.9), R0 resection rate (100 vs 100 %), morbidity incidence (Clavien-Dindo grade I&II ; 61.2%(8/13) vs 50.0%(2/4), P=0.68), and (Clavien-Dindo IIIa&IIIb ; 7.7%(1/13) vs 50%(2/4), P=0.07) were similar between the laparoscopic and open group. After a median follow-up of 582 days, local re-recurrence was found in 4 patients (1 in open and 3 in laparoscopic), brain metastasis was found in 1 patient (in laparoscopic), lung metastasis was found in 1 patient (in laparoscopic) and brain and lung metastasis was 2 patients (1 in open and 1 in laparoscopic). Local re-recurrence after LPLN resection rate was higher in non-respoders than in responders (50% and 0%, P=0.08).
Conclusions: Laparoscopic surgery for LPLN metastasis was feasible and less invasive than open surgery. Laparoscopic radical resection of LPLN might be justified in some cases for cure intent. Patients with incomplete pathologic response to neoadjuvant therapy should be followed carefully and adjuvant therapy must be considered.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79883
Program Number: P207
Presentation Session: Poster (Video to Poster) (Non CME)
Presentation Type: Poster
