Bilateral Pelvic Lymphadenectomy in Rectal Cancer with Total Mesorectal Excision

Document Type : Original Article

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Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Abstract

Background: Total mesorectal excision [TME] is regarded as the standard procedure in rectal cancer surgery to decrease local recurrence. However, controversy still exists on the integration of TME with lateral pelvic lymph node dissection [LPLD].
Aim of the work: This study aimed to evaluate the result of TME with LPLD in patients with resectable rectal carcinoma.
Patients and Methods: This prospective interventional study included 60 patients with rectal cancer and submitted for total mesocolic excision. Awareness of operative findings, postoperative course, and cancer-related prognosis was determined. Data collected was also subjected to a set of Statistical tests to compare aspects such as mean specimen length, mean lymph node retrieve, mean operative time, mean blood loss, ICU admission status, mean time taken for gastrointestinal function, mean hospital length of stay, and mean recurrence rate on the two groups.
Results: Regarding the perioperative data, operative time and intra-operative blood loss were quantitatively higher in Group A than in Group B [P = 0.034 and P = 0.003, respectively] as well as the resection time [P = 0. 031]. Group B suffered from a high recurrence rate of 33. 3% compared to 13. 3% of Group A [P= 0. 021]. The result showed that the mortality rates of the subjects were nearly similar and were not statistically significantly different between sample A and sample B [P = 0. 231].
Conclusion: Our study reveals that TME with LPND is presented as an effective method to decrease local recurrence while increasing the operation time and blood loss. These adverse outcomes must be considered when generalizing the LPLN, especially for patients with a high risk of lateral pelvic lymph node involvement. 

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