Laparoscopic Extraperitoneal Approach to Bilateral Pelvic Lymph Node Dissection in Low Rectal Cancer: Technique with...

Area of Science:

• Surgical Oncology
• Rectal Cancer Treatment
• Minimally Invasive Surgery

Background:

• Lateral pelvic lymph node dissection is crucial for preventing rectal cancer recurrence.
• The complex pelvic anatomy presents challenges for this surgical technique.
• Selective lateral lymphadenectomy is vital for specific patient groups.

Observation:

• A 65-year-old patient with locally advanced rectal adenocarcinoma underwent laparoscopic extraperitoneal dissection.
• The procedure included total mesorectal excision, complete mesocolic excision, and bilateral lateral lymph node dissection.
• The extraperitoneal space was accessed via combined transanal and transabdominal approaches.

Findings:

• The surgery lasted 303 minutes with 270 ml blood loss; no intraoperative complications occurred.
• Bilateral lymph node dissection preserved the obturator nerve and neurovascular bundle.
• Postoperative pelvic infection (Clavien 3a) was managed without anastomotic leakage; final pathology showed T3N1M0 adenocarcinoma with clear margins.

Implications:

• The laparoscopic extraperitoneal approach is a viable option for lateral pelvic lymph node dissection.
• A transanal approach may enhance visualization and access to the distal internal iliac region.
• This technique can assist oncologic surgeons in performing complex lateral lymph node dissections.