Application value of fascia orientation in lateral lymph node dissection of low rectal cancer

Abstract

Lateral lymph node metastasis is an important pathway for metastasis of low rectal cancer, which is also one of the most important risk factors for bad prognosis. Numerous evidences from evidence-based medicine demonstrate that both preoperative and postoperative chemoradiotherapy cannot eradicate lateral lymph node metastasis. Since selective resection of lateral lymph nodes with tumor residue after chemoradiotherapy can significantly decrease local recurrence rate and improve cancer prognosis, it is the only treatment modality for these patients to achieve disease-free survival. However, because of the narrow space, complicated anatomy and dense vessels and nerves of lateral area around rectum, lateral lymph node dissection (LLND) has many problems, such as long operation time, excessive intraoperative bleeding, piecemeal resection of lymphoid issue and high morbidity of postoperative complications, which restrict the clinical promotion of LLND. With the development in the study of fascia anatomy, surgeons are gradually familiarized with the perirectal fascia. Partitioning rectal lateral space and performing LLND based on fascia orientation can provide clear surgical plane and dissection boundary. Furthermore, it can avoid insufficient and excessive resection. Moreover, resecting tissue along fascia structure can avoid entering lymph tissue and prevent dissemination of malignant cells. Meanwhile, it can reduce exudation and bleeding, and present better pelvic autonomic nerve preservation. LLND based on fascia orientation is more in line with the concept of modern anatomy, more efficient both in tumor radical resection and function protection, and contributes to the promotion and quality control of LLND.