Outcomes of Laparoscopic Versus Open Lateral Lymph Node Dissection Following Total Mesorectal Excision for Advanced...

This study aims to compare laparoscopic vs open lateral pelvic lymph node dissection (LPLND) for locally advanced rectal cancer to assess operative outcomes and postoperative complications. A systematic search was conducted in PubMed, Scopus, and the Cochrane Central Register of Clinical Trials for studies published up to June 2025. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using I² statistics, and statistical analyses were performed in R Software version 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria). Eight retrospective trials involved 896 patients undergoing total mesorectal excision plus LPLND for treatment of rectal cancer, of whom 470 (52.4%) underwent the laparoscopic and 426 (47.6%) open surgery. The laparoscopic group showed lower intraoperative blood loss (MD = -732.8 ml; 95% CI: -1328.1 to -83.5; p = 0.03; I² = 95%) and lower need for blood transfusion (OR = 0.28; 95% CI: 0.16 to 0.49; p < 0.0001; I² = 6%). Trends favoring the laparoscopic group were observed for overall postoperative complications (OR = 0.65; 95% CI: 0.41 to 1.01; p = 0.057; I² = 50%), and wound infection (OR = 0.54; 95% CI: 0.28 to 1.03; p = 0.063; I² = 0%). No statistically significant differences were observed between groups for abdominal abscess, intestinal obstruction, Clavien-Dindo complications grade ≥ 3, lower limb neuropathy, anastomotic and lymphatic leakage, total lymph nodes harvested, LPLN harvested, operative time, postoperative hospital stay, and time to a soft diet. In conclusion, laparoscopic LPLND has been associated with reduced intraoperative blood loss and seems to confer improved safety and effectiveness in the treatment of rectal cancer.