Transanally assisted lateral pelvic lymph node dissection for rectal cancer.
Transanally assisted lateral pelvic lymph node dissection for rectal cancer.
复制标题
经肛门辅助直肠癌侧盆腔淋巴结清扫术。
DOI：
10.1007/s00464-022-09617-9
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kakeji Y.
中科院分区：
文献类型：
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作者：
Matsuda T;Sawada R;Hasegawa H;Yamashita K;Utsumi M;Harada H;Urakawa N;Goto H;Kanaji S;Oshikiri T;Kakeji Y.
研究背景虽然盆腔外侧淋巴结清扫术（LLND）可能是治疗直肠癌侧方淋巴结转移的有效方法，但由于盆腔深部解剖的复杂性和位置的特殊性，其技术难度较大。经肛门入路的辅助可能有助于LLND.MethodsFrom 2016年9月至2021年5月，39例低位直肠癌患者接受了经肛门全直肠系膜切除术与LLND。其中，18例患者仅使用传统腹腔镜方法进行LLND，而其余21例患者使用传统和经肛门方法进行LLND。结果经肛组每侧LLND手术时间明显短于经肛组（105 min vs.54 min，P < 0.001）。经肛门组的术中失血量也显著较少（40 g vs. 0 g，P= 0.031）。经肛组术后并发症≥ Clavien-Dindo分级II级的发生率明显低于经肛组（66. 7% vs. 28.6%，OR：5.000，95%可信区间：1.313- 19.047，P = 0.040）。在两组中收获的外侧淋巴结的数量是相似的（8.5与8，P= 0.544）。ConclusionThe transanal的方法LLND减少手术时间，失血量和发病率相比，传统的方法单独在一个队列的直肠癌患者。
BackgroundAlthough lateral pelvic lymph node dissection (LLND) might be an effective approach for patients with rectal cancer with lateral lymph node metastasis, it is technically challenging because of the anatomical complexity and location of the deep pelvis. An assistance by transanal approach might be useful for a successful LLND.MethodsFrom September 2016 to May 2021, 39 patients with low rectal cancer underwent transanal total mesorectal excision with LLND. Among them, 18 patients underwent LLND using a conventional laparoscopic approach alone, while the remaining 21 underwent LLND using both conventional and transanal approaches. Their clinical outcomes were retrospectively compared.ResultsThe operation time for LLND on each side was significantly shorter in the transanal group (105 min vs. 54 min, P < 0.001). The intraoperative blood loss was also significantly less in the transanal group (40 g vs. 0 g,P= 0.031). The rate of overall postoperative complications ≥ grade II according to the Clavien–Dindo classification was significantly less in the transanal group (66.7% vs. 28.6%, odds ratio: 5.000, 95% confidence intervals: 1.313–19.047,P= 0.040). The number of harvested lateral lymph nodes in both groups was similar (8.5 vs. 8,P= 0.544).ConclusionThe transanal approach for LLND reduced operative time, blood loss, and morbidity compared with the conventional approach alone in a cohort of patients with rectal cancer.