Wong KY, Tan AM. Short term outcomes of minimally invasive selective lateral pelvic lymph node dissection for low rectal cancer. World J Gastrointest Surg 2020; 12(4): 178-189 [PMID: 32426097 DOI: 10.4240/wjgs.v12.i4.178]
Corresponding Author of This Article
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
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
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World J Gastrointest Surg. Apr 27, 2020; 12(4): 178-189 Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.178
Table 1 Clinicopathological characteristics of the patients (n = 22)
Sex (n)
Male
18
Female
4
Age (yr, mean, range)
65 (44–81)
ASA grade (%)
1
1 (4.5)
2
19 (86.4)
3
2 (9.1)
Histology (%)
Adenocarcinoma
20 (90.9)
Neuroendocrine
2 (9.1)
Distance from anal verge (cm)
5 (2–7)
BMI (kg/m2, mean, range)
23.4 (14.2–34.3)
Pre-op chemoradiation (%)
18(81.8)
Final TNM stage (%)
I
1 (4.5)
II
4 (18.2)
III
14 (63.6)
IV
1 (4.5)
Pathological complete response
1 (4.5)
Isolated LN recurrence
1 (4.5)
No. of lymph nodes harvested per side (median, range)
10 (3-22)
Patients with positive LPLN metastases on final histology (%)
8 (36.4)
Median size pretreatment LPLN (mm)
10
Table 2 Perioperative variables
Access (%)
Robotic
19 (86.4)
Laparoscopic
3 (13.6)
Type of surgery (%)
Low anterior resection
16 (72.7)
Low anterior resection with intersphincteric resection
2 (9.1)
APR
2 (9.1)
Hartmann’s procedure
1 (4.5)
Isolated LPND
1 (4.5)
Laterality of LPND (%)
Unilateral
18 (81.8)
Bilateral
4 (18.2)
Operative time for LPND (min, median, range)
70 (35-120)
Total blood loss (mL, median, range)
100 (50-500)
Conversion to open surgery (%)
1 (4.5)
Table 3 Post-operative variables
Length of stay (d, median, range)
7.5 (3-76)
Day to removal of urinary catheter (median, range)
3 (1-37)
Complications (%)
Lymphocele requiring drainage
1 (4.5)
Anastomotic leak
1 (4.5)
Follow up duration (mo, median, range)
18(1-36)
Local recurrence during follow up
0
Table 4 Analysis of lymph node size and response to neoadjuvant treatment
No.
Pre-op CRT
Pre-CRT Size(mm)
Post-CRT Size(mm)
LN positivity
Remarks
1
Yes
6
6
No
2
Yes
8
5
No
3
No
7
NA
No
Previous radiation for prostate cancer
4
Yes
8
0
No
Enlarged LPLN resolved after CRT
5
Yes
7/7 (L/R)
4/6 (L/R)
No
6
Yes
11
10
No
7
Yes
8
5
No
8
No
15
NA
Yes
Neuroendocrine tumor
9
Yes
10
8
No
10
Yes
11/8 (L/R)
7/8 (L/R)
Yes
Only the left side was positive for metastases
11
Yes
10
8
Yes
12
No
6
NA
No
Not suitable for CRT in view of performance status and poor social support
13
Yes
5
5
Yes
14
Yes
9
7
No
15
Yes
10
NA
Yes
Isolated LPLN recurrence after TME surgery 1 yr ago
16
No
10
NA
Yes
Neuroendocrine tumor
17
Yes
11
11
No
18
Yes
11
5
No
19
Yes
14
10
Yes
20
Yes
6
6
No
21
Yes
7
7
No
22
Yes
7
6
Yes
Citation: Wong KY, Tan AM. Short term outcomes of minimally invasive selective lateral pelvic lymph node dissection for low rectal cancer. World J Gastrointest Surg 2020; 12(4): 178-189