Surgical techniques of laparoscopic peritonectomy plus paraaortic lymph node dissection for the treatment of patients with positive lymph node metastasis and peritoneal seeding from rectosigmoid cancer.

BACKGROUND: This multimedia article demonstrates the surgical techniques of laparoscopic pelvic peritonectomy plus aggressive lymph node dissection over the abdominal aorta and inferior vena cava for the treatment of rectosigmoid cancer.
METHODS: The surgical procedures are detailed in the attached video.
RESULTS: This study enrolled 17 patients. All the patients successfully underwent surgery by the described surgical technique and had a zero conversion rate, an acceptable operation time (median 284 min, range 240-360 min), and moderate blood loss (median 294 ml, range 140-740 ml) through five small wounds (four 1-cm wounds for 5-12-mm abdominal ports and one 5-cm wound for tumor retrieval). The number of dissected lymph nodes was adequate (median 44, range 32-68). The operative complications represented 29.4% of all cases including anastomotic leakage in two cases, wound infection in two cases, and urinary retention followed by repeated urinary tract infection in one case. The patients had quick functional recovery, as evaluated by the length of the postoperative ileus (median 72 h, range 36-144 h), the hospital stay (median 14 days, range 12-28 days), and the degree of postoperative pain (visual analog scale median 4.0, range 3-6).
CONCLUSION: Laparoscopic surgery can be performed safely for rectosigmoid cancer patients with pelvic peritoneal seeding and extensive abdominal paraaortic lymph node metastases requiring an extended abdomino-iliac lymphadenectomy plus curative pelvic peritonectomy.