Exploratory analysis of lateral pelvic sentinel lymph node status for optimal management of laparoscopic lateral lymph node dissection in advanced lower rectal cancer without suspected lateral lymph node metastasis

BMC Cancer

Nozomu Nakai¹  Masayoshi Yasui¹  Hidenori Takahashi¹  Masayuki Ohue¹  Hajime Ushigome¹  Takeshi Omori¹  Naotsugu Haraguchi¹  Chu Matsuda¹  Hiroshi Wada¹  Hiroshi Miyata¹  Junichi Nishimura¹  Keijiro Sugimura¹  Shiki Fujino²  Norikatsu Miyoshi²  Yusuke Takahashi³  Shingo Noura⁴ 

[1] Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-ku, Osaka City, Osaka, Japan;Department of Gastroenterological Surgery, Osaka University, Osaka, Japan;Department of Surgery, Osaka National Hospital, Osaka, Japan;Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan;

关键词: Rectal cancer;    Sentinel lymph node;    Lateral lymph node dissection;    Laparoscopic surgery;   

DOI  :  10.1186/s12885-021-08480-6

来源: Springer

【 摘 要 】

BackgroundTotal mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiotherapy (RT) are standard treatment for lower cT3/4 rectal cancers in Eastern countries. In comparative studies, both TME + LLND and RT + TME yield good local control. Although Japanese guidelines recommend LLND for locally advanced rectal cancers below the peritoneal reflection, LLND dissection of clinically negative lateral pelvic lymph nodes (LPLN) is controversial, and laparoscopic TME + LLND is technically challenging and time-consuming. New optical instruments for laparoscopy allow easy perioperative sentinel lymph node (SLN) identification using ICG. The SLN concept may facilitate accurate diagnosis of LPLN involvement, and thus reduce LLND in laparoscopic rectal cancer surgery. Here we investigated lateral pelvic SLN navigation surgery for SLN detection during laparoscopic rectal cancer surgery.MethodsThis study included 21 patients with clinical StageII/III lower rectal cancer without LPLN enlargement, who underwent curative laparoscopic surgery. All patients underwent TME, followed by lateral SLN identification and biopsy using ICG, and then laparoscopic LLND. ICG fluorescence imaging was conducted using the laparoscopic near-infrared camera system.ResultsLateral SLNs were successfully identified in 16 (76.2%) of the 21 patients. Among the 15 patients without SLN tumor metastasis, the dissected lateral non-SLNs were all negative.ConclusionsA lack of metastasis in the lateral pelvic SLN seems to reflect a lack of metastases to all lateral LNs. Our present results suggest that this laparoscopic ICG-guided SLN strategy may be a low-risk and time-saving method to prevent laparoscopic LLND in cases with negative lateral pelvic lymph nodes.

【 授权许可】

CC BY