Comparison of laparoscopic lateral lymph node dissection for rectal cancer with and without routine resection of the visceral branches of internal iliac artery

Abstract

Abstract Background:The lateral-pelvic recurrence after lateral lymph node (LLN) dissection (LLND) in patients with lateral lymph node metastasis (LLNM) remained high, especially in the absence of neoadjuvant chemoradiotherapy. Incomplete resection of lymphatic tissue in the lateral compartment, given the complex anatomy and variation of the internal iliac vessels, might contribute to the local failure. This study aimed to explore the safety and feasibility of the modified LLND with routine resection of the visceral branches of internal iliac vessels (IIVs) for mid-low-lying rectal cancer. Materials and method: Consecutive patients undergoing LLND for rectal cancer were divided into the RVR group (routine visceral branches of the IIVs resection group) and the NRVR group (without routine resection). The main outcomes were postoperative complications and the number of LLN harvested. Results: From 2012 to 2021, a total of 75 and 57 patients were included in the RVR and NRVR group, respectively. The operative time was reduced in the RVR group (P=0.020). No significant difference was observed between the two groups for the incidence of total, major, or minor postoperative complications. Pathologically confirmed LLNM were 24 (32%) patients in the RVR group and 12 (21.1%) in the NRVR group (P=0.162). The number of LLN harvested had no significant difference between two groups (11 vs 12, P=0.329). Conclusion: LLND with routine resection of visceral branches of IIVs is safe and feasible, which is promising to improve LLN clearance and the detection rate of LLNM without bringing additional major complications or harm to long-term urinary function.