Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Lateral pelvic lymph node (LPN) involvement occurs in 15-25% of rectal cancer cases, particularly those below the peritoneal reflection.
• Total mesorectal excision (TME) removes locoregional nodes but not LPN.
• Lateral pelvic lymph node dissection (LPND) is indicated for persistent LPN after neoadjuvant chemoradiotherapy (NACTRT) in advanced rectal cancers.

Purpose of the Study:

• To evaluate the initial experience and outcomes of LPND in patients with advanced rectal cancer and persistent pelvic nodes after NACTRT.

Main Methods:

• Eight patients with persistent pelvic nodes after NACTRT underwent TME with LPND between October 2013 and November 2014.
• LPND was performed based on preoperative MRI findings of persistent pelvic node metastasis.
• Clinicopathological and perioperative data were collected.

Main Results:

• Five percent (8/144) of patients with locally advanced rectal cancer (LARC) had persistent LPN post-NACTRT and underwent TME with LPND.
• Median operative time was 240 minutes, median blood loss was 800 mL.
• 25% (2/8) of patients had residual disease in LPN; one also had residual mesorectal nodes. Median hospital stay was 6 days. No genitourinary complications were reported.
• Median follow-up was 13 months, with 100% 1-year disease-free survival and no mortality.

Conclusions:

• LPND is a feasible surgical option for carefully selected advanced rectal cancer patients with persistent LPN after NACTRT.
• The procedure demonstrated acceptable perioperative outcomes and excellent short-term oncological results.