Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer

被引:0
|
作者
Hui-Hong Jiang [1 ,2 ]
Hai-Long Liu [1 ,2 ]
A-Jian Li [1 ]
Wen-Chao Wang [1 ]
Liang Lv [1 ]
Jian Peng [1 ]
Zhi-Hui Pan [1 ]
Yi Chang [1 ,2 ]
Mou-Bin Lin [1 ,2 ]
机构
[1] Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine
[2] Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine
基金
中国国家自然科学基金;
关键词
Locally advanced low rectal cancer; Lateral lymph node dissection; Fascial anatomy; Visceral fascia; Vesicohypogastric fascia; Cardinal ligament;
D O I
暂无
中图分类号
R735.37 [];
学科分类号
100214 ;
摘要
BACKGROUND The procedure for lateral lymph node(LLN) dissection(LLND) is complicated and can result in complications. We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises, and the fascial composition related to LLND was observed and described. Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC, and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery, and the last three fasciae formed two spaces(Latzko’s pararectal space and paravesical space) which were the surgical area for LLND. Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients. The median operating time, blood loss and postoperative hospitalization were 178(152-243) min, 55(25-150) mL and 10(7-20) d, respectively. The median number of harvested LLNs was 8.6 (6-12), and pathologically positive LLN metastasis was confirmed in 7(35.0%) cases. Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible, effective and safe procedure for treating LALRC.
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收藏
页码:3654 / 3667
页数:14
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