Selective laparoscopic lateral dissection of regional micrometastasis in rectal carcinoma--ten years single center...

Although total mesorectal excision (TME) has been generally accepted as a principle of rectal cancer surgery, the corresponding laparoscopic approach still needs evaluation in depth, especially the controversial dissection of lateral pelvic areas. At our center, 982 patients with rectal cancers received laparoscopic or laparoscopic-assisted surgery during the past ten years. Short-term results showed an anastomic leakage rate of 4.2% (29/683) in patients with anal sphincter preservation and an average hospitalization of 8.8 days. Sixty-two cases (6.3%) suffered postoperative urinary dysfunction while well-controlled defecation was observed in 87.6% cases that underwent colo-rectal/colo-anal anastomosis. According to our experience, the laparoscope amplifies the local view within the narrow pelvis, thus facilitating the identification of surgical plane and adjacent structures. The radial, proximal and distal distribution of mesorectal micrometastases underline the importance of total mesorectal excision and the sharp dissection between parietal and visceral pelvic fascia is essential for better clearance and nerve protection. Lateral metastasis was more common in lower located cancers while laparoscopic lateral dissection is practical and safe when performed by trained surgeons. Lateral dissection is advised when preoperative imaging or intraoperative exploration suggest the existence of lateral metastasis.