Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1080-1092
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1080
Fascia- vs vessel-oriented lateral lymph node dissection for rectal cancer: Short-term outcomes and prognosis in a single-center experience
Wei Zhao, Zhi-Jie Wang, Shi-Wen Mei, Jia-Nan Chen, Si-Cheng Zhou, Fu-Qiang Zhao, Ti-Xian Xiao, Fei Huang, Qian Liu
Wei Zhao, Zhi-Jie Wang, Shi-Wen Mei, Jia-Nan Chen, Si-Cheng Zhou, Fu-Qiang Zhao, Ti-Xian Xiao, Fei Huang, Qian Liu, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Zhao W and Wang ZJ contributed equally to this work; Liu Q contributed to the study conception and design; material preparation, data collection and analysis were performed by Zhao W, Wang ZJ, Mei SW, Chen JN, Zhou SC, Zhao FQ, Xiao TX, and Huang F; the first draft of the manuscript was written by Zhao W and Wang ZJ, and all authors commented on previous versions of the manuscript; All authors read and approved the final manuscript.
Supported by Grants from CAMS Innovation Fund for Medical Sciences (CIFMS), No. 2022-I2M-C&T-B-057; The National Key Research and Development Program, No. 2022YFC2505003 and No. 2019YFC1315705; The Medicine and Health Technology Innovation Project of The Chinese Academy of Medical Sciences, No. 2017-12M-1-006; and The Special Fund of China Cancer Research Foundation/Beijing Hope Marathon, No. LC2017L03.
Institutional review board statement: The study was performed in accordance with the ethical standards of the National Cancer Center ethics committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was reviewed and approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Institutional Review Board, No. 17-116/1439.
Informed consent statement: Written informed consent was obtained from the patients or their legally authorized representatives.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article. The original anonymous dataset is available on request from the corresponding author at liuqncc@foxmail.com.
STROBE statement: The authors have read STROBE Statement, and the manuscript was prepared and revised according to 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Liu, Doctor, MD, Chief Doctor, Professor, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. liuqncc@foxmail.com
Received: January 26, 2023
Peer-review started: January 26, 2023
First decision: March 15, 2023
Revised: April 2, 2023
Accepted: April 23, 2023
Article in press: April 23, 2023
Published online: June 27, 2023
Processing time: 139 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background

There is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented lateral lymph node dissection (LLND). Through a preliminary study with a small sample size, we found that fascia-oriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined lateral lymph nodes (LLNs). In this study, we increased the sample size and refined the postoperative functional outcomes.

Research motivation

For the management of LLN metastasis in patients with rectal cancer, selective LLND is gradually being accepted by Chinese scholars. Theoretically, fascia-oriented LLND both allows radical tumor resection and protects organ function. However, there is a lack of evidence-based medical studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND. The present study will provide information for surgeons regarding the selection of the optimal surgical procedure for LLND.

Research objectives

This study aimed to compare the effects of fascia- and vessel-oriented LLND regarding the short-term outcomes and prognosis.

Research methods

We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021. The short-term outcomes included perioperative outcomes and postoperative functional outcomes. The prognosis was measured based on overall survival (OS) and progression-free survival (PFS).

Research results

Regarding short-term outcomes, the fascia-oriented group had a higher median number of examined LLNs compared to the vessel-oriented group. However, there were no notable differences in other short-term outcomes. The fascia-oriented group had significantly lower rates of postoperative urinary and male sexual dysfunction compared to the vessel-oriented group, and there were no significant differences in postoperative lower limb dysfunction between the two groups. As for prognosis, there was no significant disparity in PFS or OS between the two groups.

Research conclusions

Our study suggests that fascia-oriented LLND is a safe and feasible option for patients with rectal cancer. Although no significant difference was observed in prognosis compared to vessel-oriented LLND, fascia-oriented LLND may allow for the examination of more LLNs and potentially offer benefits in preserving postoperative urinary and sexual function.

Research perspectives

While our study supports the use of fascia-oriented LLND for rectal cancer, it is important to verify our conclusions with larger prospective studies. Further research is needed to confirm the potential benefits of fascia-oriented LLND, including preserving postoperative urinary and sexual function.