NERVE-SPARING TOTAL MESORECTAL EXCISION AND LATERAL PELVIC LYMPHADENECTOMY FOR ADVANCED RECTAL CANCER IN WESTERN PATIENTS

Aims.To evaluate the impact of body mass index (BMI) on the surgical outcome of laparoscopic total mesorectal excision (laTME) for locally advanced rectal cancer (LARC, clinically staged as UICC stage II/III) after neoadjuvant chemoradiotherapy (nCRT).Methods.312 LARC patients undergoing laTME after nCRT were divided into nonobese (BMI < 25.0 kg/m2,n=249) and obese (BMI ≥ 25.0 kg/m2,n=63) groups. Preoperative radiotherapy was delivered in 45–50.4 Gy/25f, 5 days/week, and concurrent chemotherapy using FOLFOX or CapeOX. Technical feasibility, postoperative and oncological outcome were compared between groups.Results.Obese patients had significantly longer operative time (P=0.004). There was no significant difference regarding estimated blood loss, conversion, postoperative recovery, and morbidities. Multivariate analysis demonstrated that higher ASA score and abdominoperineal resection were risk factors for postoperative complications and diverting stoma was a protective factor. The length of resection margin, circumferential resection margin involvement, and number of lymph node retrieved were comparable. With a median follow-up time of 55 months (ranging 20–102 months), oncological outcome was comparable in terms of overall survival, local recurrence, and distant metastasis.Conclusions.Obesity does not affect surgical or oncological outcome of laTME after nCRT. LaTME may be feasible and safe to obese LARC patients after nCRT in a specialized center.

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Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision

International Journal of Colorectal Disease ◽

10.1007/s00384-015-2165-2 ◽

2015 ◽

Vol 30 (6) ◽

pp. 769-774 ◽

Cited By ~ 43

Author(s):

Radhika K. Smith ◽

Robert D. Fry ◽

Najjia N. Mahmoud ◽

E. Carter Paulson

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Clinical Response ◽

Neoadjuvant Therapy ◽

Advanced Rectal Cancer ◽

Complete Clinical Response ◽

Mesorectal Excision

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Role of pelvic lymphadenectomy in rectal cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20192150 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1838

Author(s):

Ibrahim H. Aboelatta ◽

Soliman A. El-Shakhs ◽

Abd Elmieniem F. Mohammed ◽

Mohammed H. Milegy

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Total Mesorectal Excision ◽

Cancer Treatment ◽

Pelvic Lymphadenectomy ◽

Mesorectal Excision ◽

Pelvic Lymph Nodes ◽

Rectal Cancer Treatment ◽

Lymph Nodes Dissection ◽

Lateral Pelvic Lymph Nodes

Background: Rectal cancer constitutes about one third of all colorectal cancer cases. Total mesorectal excision has become the gold standard in rectal cancer treatment. However total mesorectal excision does not involve any approaches for lateral pelvic lymph nodes (LPLN), which may be asource of local recurrences. Tumor containing LPLN were reported to be found in about 10%-20% of the rectal cancer patients. In japan lateral pelvic lymph node metastasis is accepted to be curable with excision.Methods: This study included 20 patients presented to Menofia Hospital for elective colorectal re sections and LPLN dissection, in the period from July 2016 to January 2019.Results: This study on 13 male (65%), 7 female (35%), all patients included in the study underwent preoperative chemoradiation according to the technique described by Marks et al. with an overall administration of 45 cGy over 5 weeks. Dissection of 180 lymph nodes was retrieved (20%) lymph nodes pathologically were positive for malignancy.Conclusions: Lateral pelvic lymph nodes dissection is an important in rectal cancer treatment.

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