Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.178
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
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).
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.
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.
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.
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.
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.
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.