Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy.

AIM: To test the technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with clinically positive lateral node(s) after preoperative concurrent chemoradiation therapy for lower rectal cancer.
METHODS: The operation procedures are detailed in the attached video.
RESULTS: Forty-five procedures of laparoscopic lateral pelvic lymphadenectomy were performed in 34 patients, with dissection over bilateral lateral node foci in 11 patients and dissection over unilateral lateral node station in 23. There were four procedures in which the metastatic node was very close to or even encased the adjacent iliac vessel and therefore the lymphadenectomy was done with a surgical margin of less than 1 mm. The median (range) number of lymph nodes harvested in each lateral station was 6 (2-14). Lympho-adipose tissues from 32 (71.1%, 32/45) lateral node dissections were confirmed by histopathology to harbor metastatic adenocarcinoma. For unilateral lateral pelvic lymph node dissection, median (range) blood loss was 44 (20-240) ml and median (range) operation time was 58 (42-94) min. There was one (2.9%) operative mortality and seven (20.6%) postoperative complications. Postoperatively, most patients presented with mild postoperative pain and quick convalescence. During follow-up (mean 24 months), nine patients (27.3%) developed recurrent disease. Remarkably, all four patients with surgical margin less than 1 mm developed cancer recurrence.
CONCLUSIONS: Laparoscopic lateral pelvic lymphadenectomy is technically feasible for some selected patients. To date, laparoscopic approach is still underdeveloped to treat the complex clinical condition in which the metastatic node involves the iliac vessel and combined resection of the vessel is required to obtain sufficient margin.