eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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abstract:
Original paper

The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

Yi Sun
1
,
Lei Lian
2
,
Hong Zhang
3
,
Xuefeng Bai
4
,
Zhongshi Xie
5
,
Jun Ouyang
6
,
Kai Wang
7
,
Hang Yuan
8
,
Chang Xu
9
,
Henggui Luo
10
,
Haijun Deng
11
,
Jun Li
12
,
Hongjie Yang
1
,
Zhichun Zhang
1
,
Peng Li
1
,
Xipeng Zhang
1

1.
Department of Colorectal Surgery, Tianjin Union Medical Centre, Tianjin, China
2.
Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
3.
Department of Colorectal Surgery, Shengjing hospital of China Medical University, Shenyang, China
4.
Department of Colorectal Surgery, Affiliated Tumour Hospital of Harbin Medical University, Harbin, China
5.
Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
6.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
7.
Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
8.
The Surgical Department of Coloproctology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
9.
Department of Colorectal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Xuzhou, China
10.
The First Department of General Surgery, Xiangtan Central Hospital, Xiangtan, China
11.
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
12.
Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Videosurgery Miniinv
Online publish date: 2021/04/09
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Introduction
Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis. Aim: To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer.

Material and methods
Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed.

Results
A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100–700 ml). The median lymph node yield was 6 (range: 1–41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I–II complications, no Clavien-Dindo III–IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the “nCRT” group and the “no nCRT” group was not significantly different (p = 0.62) either. There were no perioperative deaths.

Conclusions
Conclusions: Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

keywords:

lateral lymph node dissection, rectal cancer, fascia space priority approach, surgical technology

  
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