局所進行低位直腸癌に対する腹腔鏡下および開腹下外側リンパ節郭清の周術期および腫瘍学的予後
1Department of Surgery, Fujieda Municipal General Hospital, Fujieda, Japan.
Background:
Metastasis to the lateral lymph nodes (LLNs) occurs in 15%-20% of patients with cT3-4 low rectal cancer and remains a key factor in local recurrence after surgery. While laparoscopic LLN dissection (LLND) is increasingly performed, its technical demands raise concerns regarding safety and efficacy. This study aimed to evaluate the feasibility, safety, and oncological equivalence of the laparoscopic approach compared with the open approach.
Methods:
This retrospective, single-centre study included 60 patients who underwent LLND between 2007 and 2022. Peri-operative and oncological outcomes were compared between the laparoscopic (n = 33) and open (n = 27) approaches. In addition, peri-operative outcomes of laparoscopic LLND were compared between the initial 16 and the subsequent 17 cases.
Results:
Blood loss was significantly reduced in the laparoscopic group (median, 200 mL vs. 794 mL; p < 0.001), with a significant reduction in the latter laparoscopic cases compared with the initial cases (100 vs. 323.5 mL; p < 0.001). Post-operative hospital stay was significantly shorter in the laparoscopic group (16 vs. 23 days; p = 0.006) and was further reduced in the latter laparoscopic cases compared with the initial cases (14 vs. 19 days; p < 0.001). No significant differences were observed in terms of 5-year cancer-specific survival (96.4 vs. 95.7%; p = 0.46), relapse-free survival (85.6 vs. 82.6%; p = 0.71), or cumulative local recurrence rates (7.1 vs. 4.3%; p = 0.69).
Conclusion:
Laparoscopic LLND provides clear short-term advantages over open dissection while achieving comparable oncological outcomes. Moreover, the peri-operative outcomes of laparoscopic LLND improve further with increasing surgical experience.
