Clinical analysis of laparoscopic lateral lymph node dissection in the treatment of mid-low rectal cancer

Abstract

Objective To evaluate the efficacy of laparoscopic lateral lymph node dissection with the preservation of the autonomic nerve in the treatment of middle and low rectal cancer. Methods The clinical data of 48 patients with rectal cancer who underwent laparoscopic lateral lymph node dissection from June 2011 to December 2016 were retrospectively analyzed. The operation, postoperative recovery and prognosis were recorded. The prognosis of the patients was analyzed. The data were analyzed by SPSS 19.0 statistical software package. The postoperative measurement data were expressed with mean standard deviation and by t test. The relationship between clinical characteristics and pathological factors and lateral lymph node metastasis was analyzed by chi square test. P<0.05 indicated that the difference was statistically significant. Results The operating time was (245.7±46.7) min, and mean blood loss was (223.7±66.0) ml. The average hospital stay time and exhaust time were (8.3±1.4) days and (3.8±0.8) days respectively. 13(27.1%) cases were suffered from transient mild-moderate urinary dysfunction, and 23 (47.9%) cases were developed sexual dysfunction. Of the 48 patients, lymph node metastasis was found in 41 patients, and lateral lymph node metastasis was found in 15 cases. A total of 648 lymph nodes were cleared, in which 304 mesenteric lymph nodes and 33(5.1%) lateral lymph node were positive. The lateral lymph node metastasis was related to the diameter of lateral lymph node, the pathological type and the TNM stage of the tumor. Followed-up 40 months, a total of 36 cases survived, 15 cases developed local recurrence, 12 cases died from metastasis, 3 cases lived with tumor, and 33 cases were disease-free survival. The patients with lateral lymph node metastasis and the group of positive lateral lymph node had a poor prognosis than the other patients. Conclusion Laparoscopic lateral lymph node dissection for patients with mid-low rectal cancer is safe and feasible, and it can improve the prognosis. Autonomic nerve-preserving surgery can effectively protect sexual function and urinary function. Key words: Rectal Neoplasms; Laparoscopy; Lymph Node Excision; Autonomic Pathways