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      The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

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          Abstract

          Introduction

          Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis.

          Aim

          To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer.

          Material and methods

          Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed.

          Results

          A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100–700 ml). The median lymph node yield was 6 (range: 1–41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I–II complications, no Clavien-Dindo III–IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the “nCRT” group and the “no nCRT” group was not significantly different (p = 0.62) either. There were no perioperative deaths.

          Conclusions

          Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

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          Most cited references17

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          Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

          Purpose Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. Patients and Methods Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. Results On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). Conclusion LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.
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            Consensus on structured training curriculum for transanal total mesorectal excision (TaTME).

            The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME.
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              Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection.

              To identify the parameters related to the effective selection of patients who could receive prognostic benefit from lateral pelvic node dissection.
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                Author and article information

                Journal
                Wideochir Inne Tech Maloinwazyjne
                Wideochir Inne Tech Maloinwazyjne
                WIITM
                Videosurgery and other Miniinvasive Techniques
                Termedia Publishing House
                1895-4588
                2299-0054
                09 April 2021
                June 2021
                : 16
                : 2
                : 312-320
                Affiliations
                [1 ]Department of Colorectal Surgery, Tianjin Union Medical Centre, Tianjin, China
                [2 ]Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
                [3 ]Department of Colorectal Surgery, Shengjing hospital of China Medical University, Shenyang, China
                [4 ]Department of Colorectal Surgery, Affiliated Tumour Hospital of Harbin Medical University, Harbin, China
                [5 ]Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
                [6 ]Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
                [7 ]Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
                [8 ]The Surgical Department of Coloproctology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
                [9 ]Department of Colorectal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Xuzhou, China
                [10 ]The First Department of General Surgery, Xiangtan Central Hospital, Xiangtan, China
                [11 ]Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
                [12 ]Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
                Author notes
                Address for correspondence Xipeng Zhang, Department of Colorectal Surgery, Tianjin Union Medical Centre, 300121 Tianjin, China. e-mail: zhangxipeng@ 123456vip.tom.com
                Article
                43767
                10.5114/wiitm.2021.105143
                8193747
                34136026
                979c0620-7762-4c47-859f-89c3498d7ad8
                Copyright: © 2021 Fundacja Videochirurgii

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 22 February 2021
                : 03 March 2021
                Categories
                Original Paper

                lateral lymph node dissection,rectal cancer,fascia space priority approach,surgical technology

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