Background

Although lateral pelvic lymph node dissection (LLND) might be an effective approach for patients with rectal cancer with lateral lymph node metastasis, it is technically challenging because of the anatomical complexity and location of the deep pelvis. An assistance by transanal approach might be useful for a successful LLND.

Methods

From September 2016 to May 2021, 39 patients with low rectal cancer underwent transanal total mesorectal excision with LLND. Among them, 18 patients underwent LLND using a conventional laparoscopic approach alone, while the remaining 21 underwent LLND using both conventional and transanal approaches. Their clinical outcomes were retrospectively compared.

Results

The operation time for LLND on each side was significantly shorter in the transanal group (105 min vs. 54 min, P < 0.001). The intraoperative blood loss was also significantly less in the transanal group (40 g vs. 0 g, P = 0.031). The rate of overall postoperative complications ≥ grade II according to the Clavien–Dindo classification was significantly less in the transanal group (66.7% vs. 28.6%, odds ratio: 5.000, 95% confidence intervals: 1.313–19.047, P = 0.040). The number of harvested lateral lymph nodes in both groups was similar (8.5 vs. 8, P = 0.544).

Conclusion

The transanal approach for LLND reduced operative time, blood loss, and morbidity compared with the conventional approach alone in a cohort of patients with rectal cancer.

中文翻译：

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经肛门辅助的侧盆腔淋巴结清扫术治疗直肠癌

背景

尽管侧方盆腔淋巴结清扫术 (lateral pelvic lymph node dissection, LLND) 可能是直肠癌伴侧方淋巴结转移的有效方法，但由于深部骨盆的解剖复杂性和位置，它在技术上具有挑战性。经肛门方法的辅助可能对成功的 LLND 有用。

方法

2016年9月至2021年5月，39例低位直肠癌患者行经肛门全直肠系膜切除术并行LLND。其中，18 名患者仅使用传统的腹腔镜方法进行了 LLND，而其余 21 名患者同时使用了传统和经肛门方法进行了 LLND。回顾性比较了他们的临床结果。

结果

经肛门组每侧 LLND 的手术时间明显缩短（105 分钟对 54 分钟，P < 0.001）。经肛门手术组的术中失血量也明显减少（40 g 与 0 g，P  = 0.031）。根据 Clavien–Dindo 分类，经肛门手术组的术后并发症 ≥ II 级的发生率明显较低（66.7% 对 28.6%，比值比：5.000，95% 置信区间：1.313–19.047，P = 0.040 ）  。两组收获的侧淋巴结数量相似（8.5 对 8，P  = 0.544）。

结论

在一组直肠癌患者中，与单独使用传统方法相比，LLND 的经肛门方法减少了手术时间、失血量和发病率。