Evaluation of Total Mesorectal Excision With or Without Lateral Pelvic Lymph Nodes Dissection for Middle and Lower Rectal Cancer

Abstract

Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival. Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020. Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection. Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.