A multicentre prospective single-arm clinical trial to evaluate the treatment outcomes of prophylactic laparoscopic lateral pelvic lymph node dissection for advanced lower rectal cancer

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-04-01 DOI:10.1111/codi.70078

Atsushi Hamabe, Junichi Nishimura, Yozo Suzuki, Masayoshi Yasui, Masakazu Ikenaga, Tsukasa Tanida, Shinichi Yoshioka, Yoshihito Ide, Yusuke Takahashi, Hiroshi Takeyama, Takayuki Ogino, Hidekazu Takahashi, Norikatsu Miyoshi, Makoto Fujii, Yuko Ohno, Hirofumi Yamamoto, Kohei Murata, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi

{"title":"A multicentre prospective single-arm clinical trial to evaluate the treatment outcomes of prophylactic laparoscopic lateral pelvic lymph node dissection for advanced lower rectal cancer","authors":"Atsushi Hamabe, Junichi Nishimura, Yozo Suzuki, Masayoshi Yasui, Masakazu Ikenaga, Tsukasa Tanida, Shinichi Yoshioka, Yoshihito Ide, Yusuke Takahashi, Hiroshi Takeyama, Takayuki Ogino, Hidekazu Takahashi, Norikatsu Miyoshi, Makoto Fujii, Yuko Ohno, Hirofumi Yamamoto, Kohei Murata, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1111/codi.70078","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>There has been no prospective multicentre validation of the treatment outcomes of minimally invasive lateral pelvic lymph node dissection for lower rectal cancer; hence, this prospective study aimed to evaluate the treatment outcomes of prophylactic laparoscopic lateral pelvic lymph node dissection.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>Between May 2018 and August 2021, 90 patients with Stage II–III rectal cancer were registered. The clearance range for lateral pelvic lymph node dissection included the lymph nodes around the internal iliac artery and the obturator lymph nodes, while the autonomic nerves were generally preserved. The primary outcome was the incidence of Grade III–IV postoperative complications at discharge. The secondary outcomes were surgical and pathological outcomes, urinary function, sexual function, disease-free survival and overall survival. The experience of each facility and surgeon requirements were set to maintain quality control of lateral pelvic lymph node dissection.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 90 patients, 87 were analysed after exclusion of ineligible patients. There were 30 and 57 cases, respectively, of Stage II and III rectal cancer, among which 17 patients underwent neoadjuvant chemotherapy. The median operating time and blood loss were 472 min and 55 mL, respectively. Postoperative complications were observed in 22 patients (25.3%), and the primary outcome of Grade III postoperative complication was observed in five patients (5.7%). Eight lateral lymph nodes were harvested bilaterally, and lateral lymph node metastasis was observed in 14 patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Prophylactic lateral pelvic lymph node dissection can be safely performed with adequately quality-controlled laparoscopic procedures.</p>\n </section>\n </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 4","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70078","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/codi.70078","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

There has been no prospective multicentre validation of the treatment outcomes of minimally invasive lateral pelvic lymph node dissection for lower rectal cancer; hence, this prospective study aimed to evaluate the treatment outcomes of prophylactic laparoscopic lateral pelvic lymph node dissection.

Method

Between May 2018 and August 2021, 90 patients with Stage II–III rectal cancer were registered. The clearance range for lateral pelvic lymph node dissection included the lymph nodes around the internal iliac artery and the obturator lymph nodes, while the autonomic nerves were generally preserved. The primary outcome was the incidence of Grade III–IV postoperative complications at discharge. The secondary outcomes were surgical and pathological outcomes, urinary function, sexual function, disease-free survival and overall survival. The experience of each facility and surgeon requirements were set to maintain quality control of lateral pelvic lymph node dissection.

Results

Of the 90 patients, 87 were analysed after exclusion of ineligible patients. There were 30 and 57 cases, respectively, of Stage II and III rectal cancer, among which 17 patients underwent neoadjuvant chemotherapy. The median operating time and blood loss were 472 min and 55 mL, respectively. Postoperative complications were observed in 22 patients (25.3%), and the primary outcome of Grade III postoperative complication was observed in five patients (5.7%). Eight lateral lymph nodes were harvested bilaterally, and lateral lymph node metastasis was observed in 14 patients.

Conclusion

Prophylactic lateral pelvic lymph node dissection can be safely performed with adequately quality-controlled laparoscopic procedures.

Abstract Image

查看原文本刊更多论文

目的目前还没有前瞻性多中心验证下段直肠癌微创侧盆腔淋巴结清扫术的治疗效果；因此，本前瞻性研究旨在评估预防性腹腔镜侧盆腔淋巴结清扫术的治疗效果。方法在2018年5月至2021年8月期间，登记了90例II-III期直肠癌患者。盆腔侧淋巴结清扫范围包括髂内动脉周围淋巴结和闭孔淋巴结，同时一般保留自主神经。主要结果是出院时 III-IV 级术后并发症的发生率。次要结果是手术和病理结果、排尿功能、性功能、无病生存率和总生存率。为保持盆腔侧淋巴结清扫术的质量控制，对各机构的经验和外科医生的要求进行了设定。结果在 90 例患者中，87 例在排除不符合条件的患者后进行了分析。II期和III期直肠癌患者分别为30例和57例，其中17例患者接受了新辅助化疗。中位手术时间和失血量分别为 472 分钟和 55 毫升。22名患者（25.3%）出现了术后并发症，其中5名患者（5.7%）出现了III级术后并发症这一主要结果。双侧共切除 8 个侧淋巴结，14 例患者出现侧淋巴结转移。结论在质量得到充分控制的腹腔镜手术中，可以安全地进行预防性盆腔侧淋巴结清扫术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.