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Abstract Purpose: The aim of this study is to analyze the safety, feasibility and short-term oncology outcomes of selective laparoscope lateral lymph node dissection(LLND) with total mesorectal excision(TME) surgery. Methods: Between December 2019 and May 2023, LLND with TME surgery was performed in 47 selected patients with advanced rectal cancer. Surgical complications and 2-year oncology survival outcomes were analyzed in the study. Results: All 47 procedures were technically successful without the need for conversion to open surgery. The mean operation time was 200.6 minutes (range, 135-321 minutes) and mean estimated blood loss was 92.9 ml (range, 10-2000 ml). The most common postoperative complications were anastomotic(8.5%,n=4), ileus (6.4%, n=3), chyle leakageleakage (4.3%, n=2). Lateral pelvic lymph node metastases(LPNM) was found in 19 (40.4%) patients. When divided into LNP positive or negative groups, there were no significant impact on the OS (94.4%vs100%, Log rank p=0.596) and LFRS(76.7%vs89.6%, Log rank p=0.210) , except DFS (58.3%vs90.2%,Log rank p=0.005). Subgroup analysis showed that there was similar short-tem survival outcomes between pN+ group and internal iliac metastasis group(Log rank p of OS,LFRS,DFS were all＞0.05). LRFS and DFS in obturator or external iliac metastasis group were worse than those in internal iliac metastasis group when the follow-up time was extended(Log rank p of LFRS, DFS were 0.05, 0.063 , respectively). Conclusion: Selective laparoscopy LLND for rectal cancer are safety and feasibility, and its complications are manageable. Oncology survival outcomes for LPNM limited to the internal iliac are similar to pN+ stage , therefor it should be treated positively.
Xue et al. (Mon,) studied this question.