Shigeki Yamaguchi, PhD, MD, Takuhisa Okada, Shintaro Ishikawa, Toshimasa Ishii, PhD, MD, Hiroka Kondo, MD, Kiyoka Hara, MD, Asami Suzuki, MD, Hiroki Shimuzu, MD, Ken-ichi Takemoto, MD, Shin-ichi Sakuramoto, PhD, MD. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center
Background: Recently lateral lymph node (LN) metastasis of rectal cancer is also recognized in Western countries. Currently our indication of lateral lymphadenectomy (LLA) is existing suspicious positive lateral lymph node metastasis by MRI or CT scan. Purpose of this study is to assess short and long term outcome of laparoscopic LLA for rectal cancer.
Method: Curative laparoscopic resection was performed for 354 lower rectal cancer since April 2007 to April 2016, and 36 patients (10.2%, 5 bilateral and 31 unilateral) underwent laparoscopic LLA starting from 2009. LLA was performed mainly for internal iliac part and obturator fossa part with autonomic nerve preservation if possible. Short and long term results were assessed.
Results: Mean age was 62.8 years old, and 29 males and 7 females were included. Procedures were; low anterior resection: 17, intersphincteric resection: 14, and abdominoperineal resection: 5. LLA was performed in 6 patients in early phase (2007-2011, 6.6%), and in 30 patients in late phase (2012-2016, 11.4%). Preoperative chemoradiation (CRT) was performed for 7 pts (19.4%). Pathological stage was; I: 2 (post CRT), II: 10, III: 24. Lateral LN metastasis positive rates were 44.4% (16/36). Number of positive lateral LN was; one: 14 pts, two bilateral: 1pt, and three unilateral: 1pt. Mean operative time was 357 minutes (230-611) and mean blood loss was 72g (0-575). Median postoperative hospital stay was 10 days (6-43). Postoperative complications were; ileus 8.3% (3/36), anastomotic leak 6.5% (2/31, one conservative, one surgical drainage), wound infection 0%, and mortality 0%, respectively. Urinary dysfunction using self-catheterization was observed 2 pts (5.6%) and they were unnecessary one month later. Five year overall survival was 90.0%. Three year and 5 year relapse free survivals was 80.8%, 51.3% in lateral LN positive and 76.8% and 69.1% in lateral LN negative, respectively. Local recurrence was observed 18.8% (3/16) in lateral LN positive and 20.0% (4/20) in lateral LN negative. Distant metastasis without local recurrence was observed 31.3% (5/16) in lateral LN positive and 10.0% (2/20) in lateral LN negative.
Conclusion: Laparoscopic lateral lymphadenectomy for selective primary rectal cancer patients was effective for local and distant metastasis control
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87632
Program Number: P251
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster