[Comparison on efficacy between fascia-oriented versus vascular-oriented lateral lymph node dissection in patients...

Area of Science:

• Oncology
• Surgical Oncology
• Rectal Cancer Surgery

Background:

• Lateral lymph node metastasis is a key factor in rectal cancer progression.
• Lateral lymph node dissection (LLND) is crucial for improving outcomes in advanced rectal cancer.
• Different surgical approaches for LLND may impact postoperative function and oncological results.

Purpose of the Study:

• To compare the efficacy and functional outcomes of fascia-oriented versus vascular-oriented lateral lymph node dissection (LLND) in rectal cancer patients.
• To evaluate the impact of LLND approach on postoperative urinary and sexual dysfunction.
• To assess the oncological outcomes, including survival rates, between the two LLND techniques.

Main Methods:

• A retrospective cohort study included 73 rectal cancer patients undergoing total mesorectal excision (TME) with LLND.
• Patients were divided into fascia-oriented (n=30) and vascular-oriented (n=43) LLND groups.
• Outcomes assessed included postoperative urinary/sexual dysfunction, lymph node yield, and survival rates (PFS, OS).

Main Results:

• Fascia-oriented LLND showed significantly lower rates of urinary dysfunction (26.7% vs. 55.8%) and male sexual dysfunction (6/15 vs. 76%) compared to the vascular-oriented group.
• The fascia-oriented group harvested more lymph nodes (9.5 vs. 6.0).
• No significant differences were observed in operation time, blood loss, complications, hospital stay, positive lymph node rate, 3-year PFS, or 3-year OS between the groups.

Conclusions:

• Fascia-oriented LLND is associated with reduced postoperative urinary and male sexual dysfunction in rectal cancer patients.
• This approach also leads to a higher number of harvested lymph nodes.
• Despite functional benefits and increased lymph node yield, fascia-oriented LLND does not demonstrate a significant advantage in long-term survival compared to the vascular-oriented technique.