Abstract
AIM: Objective to evaluate the clinical value of therapeutic lateral lymph node dissection in advanced rectal cancer after neoadjuvant radio-chemotherapy in patients with peritoneal retroperitoneum under MR suggesting perivascular iliac lymph node enlargement (lymph node diameter > 8mm). Methods: Because of this study is a retrospective study, the propensity to evaluate matching group is adopted to one group to Fujian Medical University Union Hospital, Fujian province hospital from January 2009 to June 2014 treated 103 cases of rectum MR images after neoadjuvant chemoradiation weeks iliac blood vessels have the progress of the lymph node enlargement period under peritoneal fold return rectal cancer line TME + therapeutic cases of lateral lymph node cleaning; In the group 2, 192 cases with the same tumor site, stage, type, gender and age as group 1 or similar were matched for the same period by propensity assessment, while the group 2 received TME only. The incidence of pelvic autonomic nerve injury after surgery, the 3-year local recurrence rate of pelvic cavity, and the 5-year tumor-free survival rate were compared between the two groups, so as to explore the clinical value of therapeutic periiliac dissection for advanced rectal cancer under peritoneal reflux. Results: The local recurrence rate of pelvic cavity in group 1 and group 2 was 2.91% (3/103) and 9.90% (19/192), respectively, 3 years after operation (P<0.05). Postoperative dysuria in group 1 and group 2 was 14.56% (15/103) and 5.21% (10/192), respectively, with significant difference (P<0.05). Postoperative sexual dysfunction in group 1 and group 2 was 12.50% (7/56) and 2.15% (2/93), respectively, with significant difference (P<0.05). The 5-year survival rates of group 1 and group 2 were 54.37% (56/103) and 51.56% (99/192), respectively, with no significant difference (P›0.05). The liver metastasis rates of group 1 and group 2 were 26.21% (27/103) and 29.17% (56/192), respectively. Lung metastasis rates in group 1 and group 2 were 19.41% (20/103) and 19.27% (37/192), respectively. Conclusion: After neoadjuvant chemoradiotherapy for advanced rectal cancer, selective lymphatic dissection along the iliac vessels guided by rectal magnetic resonance can reduce the local pelvic recurrence of patients for 3 years, but increase the probability of pelvic autonomic nerve injury, and periiliac lymph node dissection will not increase the 5-year survival rate of patients.
Highlights
Background and ForewordNowadays, for advanced rectal cancer under peritoneum reflux, the choice of comprehensive treatment and surgical method is still controversial
Only the ventral serous membrane of the intestine exists in the rectum, and the visceral layer and parietal layer of the pelvic cavity are surrounded by peritoneum on both sides and dorsal side, and the surrounding tissues are mesenteric, containing a large amount of lymphatic adipose tissue [2]
International Journal of Clinical Oncology and Cancer Research 2020; 5(4): 93-104 lymph node dissection studies have shown that under the peritoneal fold return the rectum lymphatic flow in addition to the upward direction path, peritoneal fold return under the existence of bilateral rectum rectal cancer blood vessels, iliac blood vessels to the lymphatic flow path, rectum lateral lymph flow is divided into three directions: 1 with bladder reproductive organ lymph flow to the pelvic floor front wall lymphatic, again to the internal iliac vessels weeks lymph nodes; 2
Summary
Background and ForewordNowadays, for advanced rectal cancer under peritoneum reflux, the choice of comprehensive treatment and surgical method is still controversial. The lateral direction passes through the pelvic plexus nerve network and crosses the internal iliac blood vessel to the obturator pore peripheral lymph node; 3. It flows posteriorly through external iliac vessels and anterior sacral vessels to lymphatic vessels in the posterior wall of the pelvic cavity. Progress in [3] period under peritoneal fold return rectal tumor, iliac blood vessels in the recent weeks have Japanese scholars reported the probability of positive lymph nodes can reach 10%, that pure line TME (Total Mesorectal Response) pelvic floor still exist the possibility of local recurrence
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