| Cancer is a leading cause of death in countries worldwide and an important obstacle to improving human life expectancy.Patients with mid low rectal cancer tend to have some chance of developing lateral lymph node metastases.Once rectal cancer is diagnosed,it should be treated immediately.And lateral lymph node metastasis is closely related to local recurrence after surgery in patients with rectal cancer.For lateral lymph node dissection,it is still controversial.Their surgical necessity,indication for surgery,and extent of surgery were not uniform.But its improving effect on the postoperative local recurrence rate of tumor patients was purposefully demonstrated.While laparoscopic lateral lymph node dissection can fully play a minimally invasive advantage by protecting vascular nerves intraoperatively and favorably preventing postoperative complications.Both East and West surgeons are now aware of the importance of lateral lymph node metastasis in patients with rectal cancer,and have also gradually acknowledged the oncological benefits of lateral lymph node dissection treatment options.Objective:To investigate the implementable type and safety of laparoscopic lateral lymph node dissection for patients with mid and low rectal cancer,and to provide some clinical basis for treatment.Methods:The diagnosis and follow-up data of 12 patients with mid low rectal cancer who underwent laparoscopic lateral lymph node dissection surgery in our hospital between June 2018 and January 2021 were retrospectively reviewed.Entry criteria: 1 The patients were all preoperatively confirmed to have rectal cancer by pathological biopsy;2.Short diameter of lateral lymph node metastasis ≥ 5 mm assessed by preoperative MRI;3.Preoperative enteroscopy or imaging diagnosed the tumor to be located in the mid lower rectal region of the patient;4.Clinical,follow-up data complete.Exclusion criteria: 1 Previous history of malignant intestinal neoplasia;2.Those with extensive adhesions in the abdominal cavity resulting from multiple previous abdominopelvic procedures;3.Those with preoperative conditions such as ileus,intestinal perforation,and intestinal hemorrhage;4.Patients whose tumors could not be R0 resected;5.Patients with presence of distant metastasis;6.Preoperatively,patients are evaluated for the presence of urinary or sexual dysfunction,combined with urethral strictures,prostatic hyperplasia,and other conditions.Data analysis was achieved using spss26.0 computational analysis package.Values that would satisfy the normal distribution were expressed in the form of mean ± standard deviation;Numerical results meeting the skewed distribution were presented as median（lower upper quartile）;Mnemonic data were presented by frequency.Comparisons of functional assessment data of relevance were analyzed by the t-test method,and P < 0.05 was considered to indicate a statistically significant difference in values.The Kaplan Meier method was applied to analyze the patients’ survival data and delineate the survival curves.Results:There were 6 males（50%）and 6 females（50%）.The mean age was 53.33 ±14.89 years and BMI was 23.86 ± 3.33kg/m2.Enteroscopy revealed a tumor 3.41± 1.57 cm in length and a tumor lower border distance of 5.25 ± 2.8 cm from the anal verge.The preoperative CEA level was 3.05（1.56-9.56）ng / L.Eight patients underwent low anterior resection of the rectum,three patients underwent abdominoperineal combined rectal cancer radical resection,and one patient underwent transabdominal rectal cancer resection with proximal stoma and distal closure.The operative time was 317.92 ± 97.34 min,and intraoperative blood loss was 85.5 ± 31.09 ml.Nine patients underwent lateral lymph node dissection on one side and three patients underwent lymph node dissection on both sides.None of the patients had intraoperative complications such as rectal perforation,presacral bleeding,or ureteral injury.A total of two patients with grade I complications developed after surgery,and were postoperative urinary retention patients,which improved after catheterization and physiotherapy,including one patient who also developed postoperative incision infection,were treated conservatively;There was one patient with grade III complications,who was a postoperative ileus patient and improved after endoscopic guidance with indwelling ileus catheter in the intestinal lumen;No anastomotic leak,anastomotic stricture or other complications occurred in all patients after surgery.Postoperative ventilation time 2（1-3.75）days,eating full liquid 4.67 ±2.77 days,withdrawing urine 5（2.25-8.75）days,and postoperative hospital stay 13± 4.26 days.Lateral lymph node metastasis was present in 4 of 12 patients,representing a metastatic rate of 33%.A total of 92 lymph nodes were lateral to dissection,8 of which were pathologically positive,with a positive dissection rate of8.7%,and all occurred in the internal and obturator lymph node regions（2 patients with internal iliac lymph node metastasis,1 patient with obturator lymph node metastasis,and 1 patient with both internal and obturator lymph node regions）.A total of 10 patients were alive after surgery（2 were found to have metastasis at 6 and 12 months after surgery,the patients were alive with posterior tumor,and 8 patients were disease-free survival status）,3 patients developed local recurrence after surgery,4patients developed distant metastasis after surgery,and 2 patients died（1 was found to have metastasis at 10 months after surgery,the metastatic site was located in the liver,and died at 14 months after surgery;1 was found to have metastasis at 6 months after surgery,the metastatic site was located in the left psoas muscle,and died at 16 months after surgery）.Two patients developed mild sexual dysfunction postoperatively,both men.So none of the score values obtained from the related urinary and sexual function questionnaire at half year after the patient’s operation were statistically different from those obtained before the operation.Conclusion:The technique of lateral lymph node dissection has evolved to this day and has been accepted by a growing number of surgical Tongren.Preliminary experience has shown satisfactory surgical safety of laparoscopic lateral lymph node dissection.It has a low rate of intraoperative and postoperative complications,which may also affect postoperative voiding and sexual function.It is of great interest to perform this procedure in patients with mid low rectal cancer,and it is worth administrating a scientifically sound strategy of individualized lateral lymph node dissection.Moreover,the lateral lymph node metastasis area in patients with mid low rectal cancer is more commonly the internal iliac and obturator lymph node areas;Of course,because the lateral lymph node dissection procedure was not performed over a long period and the number of cases eligible for relevant enrollment and the length of patient follow-up were still slightly inadequate,it is necessary to initiate more multicenter,large-scale studies to further explore the advantages and more scientifically comprehensive indications for lateral lymph node dissection procedures. |
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