Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2020; 12(4): 178-189
Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.178
Short term outcomes of minimally invasive selective lateral pelvic lymph node dissection for low rectal cancer
Kar Yong Wong, Aloysius MN Tan
Kar Yong Wong, Aloysius MN Tan, Colorectal Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Wong KY designed the study, analyzed and interpreted the data, wrote and revised the final manuscript for submission; Tan AMN participated in the data collection and analysis, co-wrote and revised the final manuscript for submission.
Institutional review board statement: This study was reviewed and approved by the National Healthcare Group Domain Specific Review Board, No. 2019/01204.
Informed consent statement: The Institution Review Board approved a waiver for patient consent as the data utilized was obtained anonymously from an existing database without patient identifiers.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: This study meets the requirements of the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kar Yong Wong, FRCS (Ed), FRCS (Gen Surg), MBChB, Associate Specialist, Surgeon, Colorectal Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kar_yong_wong@ttsh.com.sg
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: March 18, 2020
Accepted: March 30, 2020
Article in press: March 30, 2020
Published online: April 27, 2020

Pelvic recurrence after rectal cancer surgery is still a significant problem despite the introduction of total mesorectal excision and chemoradiation treatment (CRT), and one of the most common areas of recurrence is in the lateral pelvic lymph nodes. Hence, there is a possible role for lateral pelvic lymph node dissection (LPND) in rectal cancer.


To evaluate the short-term outcomes of patients who underwent minimally invasive LPND during rectal cancer surgery. Secondary outcomes were to evaluate for any predictive factors to determine lymph node metastases based on pre-operative scans.


From October 2016 to November 2019, 22 patients with stage II or III rectal cancer underwent minimally invasive rectal cancer surgery and LPND. These patients were all discussed at a multidisciplinary tumor board meeting and most of them received neoadjuvant chemoradiation prior to surgery. All patients had radiologically positive lateral pelvic lymph nodes on the initial staging scans, defined as lymph nodes larger than 7 mm in long axis measurement, or abnormal radiological morphology. LPND was only performed on the involved side.


Majority of the patients were male (18/22, 81.8%), with a median age of 65 years (44-81). Eighteen patients completed neoadjuvant CRT pre-operatively. 18 patients (81.8%) had unilateral LPND, with the others receiving bilateral surgery. The median number of lateral pelvic lymph nodes harvested was 10 (3-22) per pelvic side wall. 8 patients (36.4%) had positive metastases identified in the lymph nodes harvested. The median pre-CRT size of these positive lymph nodes was 10mm. Median length of stay was 7.5 d (3-76), and only 2 patients failed initial removal of their urinary catheter. Complication rates were low, with only 1 lymphocele and 1 anastomotic leak. There was only 1 mortality (4.5%). There have been no recurrences so far.


Chemoradiation is inadequate in completely eradicating lateral wall metastasis and there are still technical limitations in accurately diagnosing metastases in these areas. A pre-CRT lymph node size of ≥ 10 mm is suggestive of metastases. LPND may be performed safely with minimally invasive surgery.

Keywords: Lateral pelvic lymph node dissection, Robotic rectal surgery, Locally advanced rectal cancer, Local recurrence, Pelvic side wall recurrence

Core tip: Lateral pelvic recurrence after rectal cancer surgery is still a major problem. There have been differences in the treatment of suspicious lateral pelvic lymph nodes between the East and West, treating this as either regional or systemic disease. Lateral pelvic lymph node dissection is a topic of debate in the treatment of these patients. In this study, we evaluate our single-center data, showing our short-term outcomes. Minimally invasive surgery, especially with the robotic platform is shown to be safe and feasible in lateral pelvic lymph node dissection.