Laparoscopic Lateral Pelvic Lymph Node Dissection for Advanced Lower Rectal Cancer: a Preliminary Vietnamese Study

Abstract

Background: Lateral pelvic lymph node dissection (LPLD) in rectal cancer has been carried out in several major centers. However, there are still many controversial issues regarding this method such as feasibility, safety, and oncological outcome. Objective: The aim of this study was to evaluate the short-term outcomes, safety, and feasibility of LPLD. Methods: This was a retrospective study. A total of 117 patients with lower rectal cancer (clinical stage II/III) below the peritoneal reflection underwent surgery between January 2019 and November 2020 at 108 Military Central Hospital, Hanoi, Vietnam. Results: Total amount of 25 patients underwent laparoscopic total mesorectal excision (TME) plus LPLD and 92 patients underwent laparoscopic TME without LPLD. The rate of lateral pelvic lymph node metastasis in the LPLD group was 16% (4/25), of which 12% (3/25) were on the left side and 4% (1/25) were on the right side. The rate of intraoperative complications in the LPLD group was significantly higher at 16.0% (4/25) compared with 3.3% (3/92) in the TME only group (p = 0.037). There were no statistically significant differences in the rate of postoperative complications between the two groups (24.0% of patients in the LPLD group compared with 26.1% patients in the no LPLD group, p = 0.832). Conclusion: Pelvic lymphadenectomy has an important role in the treatment of advanced lower rectal cancer. LPLD is a safe and feasible procedure. However, it is necessary to study a larger number of patients with a longer follow-up period to fully evaluate oncological outcomes.