Laparoscopy-assisted lateral pelvic lymph node dissection for advanced rectal cancer

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic surgery for advanced lower rectal cancer is limited in Japan due to challenges in managing lateral pelvic lymph node metastasis.
• Traditional open surgery allows for comprehensive lateral pelvic lymph node dissection, a critical step in treating advanced rectal cancer.

Purpose of the Study:

• To describe a new laparoscopic technique for lateral pelvic lymph node dissection in advanced rectal cancer.
• To adapt open surgical principles for lateral pelvic lymph node management within a laparoscopic approach.

Main Methods:

• Laparoscopic total mesorectal excision followed by an 8 cm supra-pubic incision.
• Blunt dissection of the latero-vesical space using forceps.
• Identification and dissection of lymph nodes in the obturator space, including the obturator nerve, facilitated by external iliac vein manipulation and fat aspiration procedure (FAP).

Main Results:

• The described technique allows for precise dissection of lateral pelvic lymph nodes, including the obturator space, during laparoscopic surgery for advanced rectal cancer.
• Fat aspiration procedure (FAP) aids in skeletonizing the obturator space and clearly identifying anatomical structures and the vascular system.
• The procedure enables lymph node dissection comparable to open surgery techniques.

Conclusions:

• This novel laparoscopic technique provides a viable option for managing lateral pelvic lymph node metastasis in advanced rectal cancer.
• The technique enhances the feasibility of minimally invasive surgery for complex rectal cancer cases, potentially improving patient outcomes.
• Further studies are warranted to evaluate the long-term efficacy and oncological safety of this approach.