Retrospective study reveals greater mesenteric artery skeletonization improves lymph node harvest in rectal cancer surgery, indicating better staging without raising complication risks.
Key Points
To evaluate the quantitative association between inferior mesenteric artery vascular pedicle skeletonization length and the quality of lymph node retrieval during laparoscopic total mesorectal excision.
Retrospective review of 299 patients with middle or low rectal adenocarcinoma undergoing laparoscopic radical resection between January 2021 and March 2025 at a single center.
Skeletonization length was quantified via operative videos, grouping patients into high (≥5.2 cm; n = 150) and low (<5.2 cm; n = 149) skeletonization cohorts.
The high skeletonization group achieved higher total lymph node retrieval [median 18 (14–23) vs 14 (11–17)], higher rates of obtaining ≥12 nodes (94.0% vs 79.2%), and higher retrieval of ≥1 No. 253 node (89.3% vs 65.8%; all P < 0.001).
Skeletonization length independently predicted retrieval of ≥12 lymph nodes (OR = 1.785, 95% CI: 1.426–2.234) and total yield (standardized β = 0.398, P < 0.001), demonstrating an AUC of 0.768 with a 4.8-cm cutoff.
High skeletonization extended operative duration by a mean of 16.2 minutes but did not increase postoperative complication rates.