Feasibility and safety of laparoscopic lateral pelvic lymph node dissection for locally recurrent rectal cancer and risk factors for re‐recurrence. Issue 4 (18th December 2019)

• Record Type: Journal Article
• Authors: Ichihara, Momoko; Ikeda, Masataka; Uemura, Mamoru; Miyake, Masakazu; Miyazaki, Michihiko; Kato, Takeshi; Sekimoto, Mitsugu
• Is Part Of: Asian journal of endoscopic surgery. Volume 13:Issue 4(2020)
• Page Start: 489
• Page End: 497
• Publication Date: 2019-12-18
• Subjects: laparoscopic surgery -- lateral pelvic lymph node dissection -- locally recurrent rectal cancer; Endoscopic surgery -- Periodicals; Endoscopic surgery -- Asia -- Periodicals; 617.05705
• DOI: 10.1111/ases.12778
• Languages: English
• ISSNs: 1758-5902

Abstract

Abstract: Introduction: Lateral pelvic lymph node (LPLN) metastasis is considered a distant metastasis. It is often treated by systemic chemotherapy and/or radiation therapy, but complete radical resection of LPLN metastasis can sometimes achieve cure. However, the safety and efficacy of radical resection for recurrent LPLN after curative rectal surgery have not been well elucidated. Therefore, we evaluated the feasibility of laparoscopic radical surgery for recurrent LPLN compared with the conventional open approach and assessed oncological outcomes between patients with and without re‐recurrence. Methods: We retrospectively reviewed 17 cases (4 open, 13 laparoscopic) who underwent radical resection for LPLN metastasis after curative rectal surgery between July 2012 and August 2016 at the National Hospital Organization Osaka National Hospital. Operative factors and short‐term outcomes were compared. Oncological outcome was evaluated based on the pathologic response to preoperative adjuvant therapy. Results: The laparoscopic group's median blood loss and C‐reactive protein elevation were lower than that of the open group on postoperative day 3. The laparoscopic group also had a shorter postoperative hospital stay. The median operative time, R0 resection rate, and morbidity rate were similar between the two groups. Local re‐recurrence after LPLN resection occurred more frequently in pathologic non‐responders than responders. Conclusion: Laparoscopic surgery for LPLN metastasis is feasible and less invasive than open surgery. Laparoscopic radical resection of LPLN may be justified for curative intent. Patients with incomplete pathologic response to neoadjuvant therapy have a greater risk of re‐recurrence.