Feasibility and safety of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced lower rectal cancer after pre-operative chemoradiotherapy

Objective: The goal of this study was to evaluate the feasibility and safety of laparoscopic lateral pelvic lymph node dissection (LPLND) following total mesorectal excision (TME) in patients with advanced lower rectal cancer treated with pre-operative chemoradiotherapy (CRT). Methods: A total of 76 patients with lower rectal cancer without distant metastasis or recurrence who underwent laparoscopic TME + LPLND were reviewed and data including the clinical characteristics, peri-operative outcomes, and pathological outcomes were analyzed. Among them, the 18 patients who received CRT (CRT group) were compared with their matched controls (non-CRT group, n=18). Results: In all 76 patients, there were no conversions to open surgery and no postoperative mortality. The operation time was significant longer and the total blood loss was significant greater in CRT group than those in non-CRT group (P=0.012, P=0.027). The complication rate and postoperative hospitalization time were similar in the two groups (P=1.000, P=0.242). The two groups also had the same number of harvested lateral pelvic lymph nodes and harvested mesorectal lymph nodes (P=1.000, P=1.000). Conclusion: LPLND following TME is technically feasible, safe, and oncologically acceptable in patients with advanced lower rectal cancer treated with pre-operative CRT, with no significant increase in postoperative morbidity compared with TME + LPLND without pre-operative CRT.