Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer.

Abstract

In 15 % to 25% of patients, the lateral pelvic lymph nodes (LPN) are known to be involved especially with rectal tumors lying below the peritoneal reflection. While total mesorectal excision (TME) ensures removal of locoregional lymph nodes, it does not address the LPN. Lateral pelvic lymph node dissection (LPND) is being performed in selected scenarios for persistent LPN after administration of neoadjuvant chemoradiotherapy (NACTRT). Through our study, we share our initial experience with LPND in patients with persistent pelvic nodes after NACTRT in advanced rectal cancers. From October 2013 to November 2014, eight patients underwent TME with LPND after NACTRT. LPND was performed when pelvic node metastasis was suspected on preoperative magnetic resonance imaging (MRI) and persisted following preoperative NACTRT. Clinicopathological and perioperative details were recorded for these eight patients. Out of the 144 patients operated with curative intent for rectal LARC, eight (5%) patients had persistent lateral pelvic nodes following NACTRT. These patients underwent a TME with LPND. The median operative time was 240min, and the median blood loss was 800mL. Two out of eight patients showed residual disease in the lateral pelvic nodes (i.e. 25%). Of these two patients, one also had residual disease in the mesorectal nodes, post NACTRT. The median length of hospital stay was 6days. No genitourinary complications were reported. The median follow up for these eight patients was 13months (6-16months). The 1year disease free survival was 100% with all patients surviving till date. LPND can be performed with acceptable perioperative outcomes in carefully selected patients.