Abstract
Introduction: There are controversies over the treatment options for pelvic lymph node metastasis in low rectal cancer. The role of neoadjuvant radiotherapy in radical treatment of pelvic lymph node metastasis is still unidentified. Total mesorectal excision (TME) with Laparoscopic pelvic lymph node dissection (LPLND) provides lower pelvic recurrence in 5 years than TME only.
Material and Methods: Prospective, uncontrolled clinical trial for patients with low rectal cancer (below peritoneal fold), who had suspected lateral pelvic lymph node metastasis on MRI scan and the patients did not have contraindication for laparoscopic surgery.
Result: From January 2017 to February 2018 we performed 12 cases of LPLND. There was no con-version to open surgery. The average time for lymphadenectomy is 75 minutes with an average amount of blood loss of 97ml. Only 1 case had postoperative urinary retention (8%). The rate of pos-itive pelvic node was 5.8%, with an average of resected nodes of 4.9 nodes. Lymph nodes size on MRI scan in the positive pelvic node group was 20.6mm, compared to 7mm in the negative group.
Conclusion: Laparoscopic lateral pelvic lymph node dissection is a feasible and safe technique and should be done by experienced colorectal surgeons. Aging, female sex and pelvic lymph node size on MRI are related to pelvic lymph node metastasis.
Optimal treatment strategies for clinically suspicious lateral pelvic lymph node metastasis in rectal cancer
