Masaaki Ito, Akihiro Kobayashi, Yusuke Nishizawa, Norio Saito. National Cancer Center Hospital East.
Backgrounds: Lymph node metastasis in pelvic sidewall space was found in 15 to 20 % of T3 low rectal cancer and pelvic sidewall dissection was performed as a standard procedure in advanced low rectal cancer in Japan. The dissection was usually done by open approach and laparoscopic pelvic sidewall dissection is not yet established as standard procedures. Objective of the study: The aim of this study is to compare short-term clinical results after laparoscopic pelvic sidewall dissection with conventional approach and to clarify benefit of laparoscopic pelvic sidewall dissection.
Methods: A total of 98 consecutive resections between July 2010 and September 2013 were included in this study. Conventional open approach was performed in 79 patients and laparoscopic approach in 19. Pelvic sidewall dissection was performed for clinical stage II or III low rectal cancers. We evaluated intra- or post-operative clinical results, and described the merits of laparoscopic sidewall dissections.
Results: Median operative time was 412min in open group and 409min in laparoscopic group. Blood loss was significantly lesser in laparoscopic group than in open group (1021ml in open groups vs 211ml in laparoscopic groups, p<0.01). Number of dissected lymph nodes in pelvic sidewall was 10 (4-27) in open group and 12 (1-22) in laparoscopic group. Hospital stay is shorter in laparoscopic group than in open group (10 days versus 13 days). Sexual function was preserved in all male patients with active sexual activity before operation in laparoscopic group.
Conclusion: The short-term results of laparoscopic pelvic sidewall dissection were clinically acceptable. Laparoscopic procedures might lead better sexual function by appropriate preservation of autonomic nerves.
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