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
Research background

Despite chemoradiation, pelvic lymph node recurrence rates are still significant. Performing lateral pelvic lymph node dissection (LPND) is increasingly being acknowledged to be able to reduce pelvic recurrence rates in patients with rectal cancer. However, it is difficult to select and predict which patients have metastatic disease in their lateral pelvic lymph nodes (LPLN).

Research motivation

LPND has an important role in complete oncological clearance to improve outcomes for patients with rectal cancer. Performing it safely using minimally invasive techniques(MIS) has further benefits for patients.

Research objectives

To present the characteristics and outcomes of our patients who underwent LPND, including lymph node characteristics which may help to predict lymph node involvement. Also, to demonstrate the safety and feasibility of performing the procedure using minimally invasive techniques.

Research methods

Ethics approval was sought for this study. Clinico-pathological characteristics, perioperative variables and post-operative outcomes were analyzed retrospectively. Further analysis of the LPLN was performed, comparing their size against the final pathological outcomes.

Research results

Our findings show that there is minimal morbidity despite all procedures being performed using minimally invasive techniques. A lateral pelvic lymph node size of 1cm or more has a higher probability of metastasis. However, more research and data are needed to be analyzed to evaluate this size criterion for accuracy in predicting lymph node metastases.

Research conclusions

In conclusion, lateral pelvic lymph node disease was shown to be inadequately treated with neoadjuvant therapy. LPND using MIS techniques is safe and feasible. LPLN that are 10mm or larger have a significant chance of having metastatic disease. However, this is a small series and further data is needed to improve the selection of patients for LPND.

Research perspectives

Further research into this field should include larger and more extensive data sets to evaluate the size criteria that most accurately predicts lateral pelvic lymph node positivity. It may also reveal other variables that may assist in selecting patients that require LPND. We also wish to highlight the benefits of using the DaVinci Robot platform for this procedure, given its stability and maneuverability in a narrow space.