The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

Yi Sun; Lei Lian; Hong Zhang; Xuefeng Bai; Zhongshi Xie; Jun Ouyang; Kai Wang; Hang Yuan; Chang Xu; Henggui Luo; Haijun Deng; Jun Li; Hongjie Yang; Zhichun Zhang; Peng Li; Xipeng Zhang

doi:10.5114/wiitm.2021.105143

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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abstract:

Original paper

The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

Yi Sun

¹

,

Lei Lian

²

,

Hong Zhang

³

,

Xuefeng Bai

⁴

,

Zhongshi Xie

⁵

,

Jun Ouyang

⁶

,

Kai Wang

⁷

,

Hang Yuan

⁸

,

Chang Xu

⁹

,

Henggui Luo

¹⁰

,

Haijun Deng

¹¹

,

Jun Li

¹²

,

Hongjie Yang

¹

,

Zhichun Zhang

¹

,

Peng Li

¹

,

Xipeng Zhang

¹

Department of Colorectal Surgery, Tianjin Union Medical Centre, Tianjin, China
Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Department of Colorectal Surgery, Shengjing hospital of China Medical University, Shenyang, China
Department of Colorectal Surgery, Affiliated Tumour Hospital of Harbin Medical University, Harbin, China
Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
The Surgical Department of Coloproctology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
Department of Colorectal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Xuzhou, China
The First Department of General Surgery, Xiangtan Central Hospital, Xiangtan, China
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Videosurgery Miniinv 2021; 16 (2): 312–320

DOI: https://doi.org/10.5114/wiitm.2021.105143

Online publish date: 2021/04/09

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AMA

Sun Y, Lian L, Zhang H, et al. The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study. Videosurgery and Other Miniinvasive Techniques. 2021:312-320. doi:10.5114/wiitm.2021.105143.

APA

Sun, Y., Lian, L., Zhang, H., Bai, X., Xie, Z.,  & Ouyang, J. et al. (2021). The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study. Videosurgery and Other Miniinvasive Techniques, 312-320. https://doi.org/10.5114/wiitm.2021.105143

Chicago

Sun, Yi, Lei Lian, Hong Zhang, Xuefeng Bai, Zhongshi Xie, Jun Ouyang,  and Kai Wang et al. 2021. "The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study". Videosurgery and Other Miniinvasive Techniques: 312-320. doi:10.5114/wiitm.2021.105143.

Harvard

Sun, Y., Lian, L., Zhang, H., Bai, X., Xie, Z., Ouyang, J., Wang, K., Yuan, H., Xu, C., Luo, H., Deng, H., Li, J., Yang, H., Zhang, Z., Li, P.,  and Zhang, X. (2021). The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study. Videosurgery and Other Miniinvasive Techniques, pp.312-320. https://doi.org/10.5114/wiitm.2021.105143

MLA

Sun, Yi et al. "The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study." Videosurgery and Other Miniinvasive Techniques, 2021, pp. 312-320. doi:10.5114/wiitm.2021.105143.

Vancouver

Sun Y, Lian L, Zhang H, Bai X, Xie Z, Ouyang J et al. The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study. Videosurgery and Other Miniinvasive Techniques. 2021:312-320. doi:10.5114/wiitm.2021.105143.

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Introduction
Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis.

Aim
To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer.

Material and methods
Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed.

Results
A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 ±103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100–700 ml). The median lymph node yield was 6 (range: 1–41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I–II complications, no Clavien-Dindo III–IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the “nCRT” group and the “no nCRT” group was not significantly different (p = 0.62) either. There were no perioperative deaths.

Conclusions
Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.

keywords:

The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

Yi Sun 1 , Lei Lian 2 , Hong Zhang 3 , Xuefeng Bai 4 , Zhongshi Xie 5 , Jun Ouyang 6 , Kai Wang 7 , Hang Yuan 8 , Chang Xu 9 , Henggui Luo 10 , Haijun Deng 11 , Jun Li 12 , Hongjie Yang 1 , Zhichun Zhang 1 , Peng Li 1 , Xipeng Zhang 1

lateral lymph node dissection, rectal cancer, fascia space priority approach, surgical technology