Lymph Node Yield in Laparoscopic Total Mesorectal Excision: Our Clinical Experience

Year 2016, Volume: 2 Issue: 1, 36 - 40, 01.01.2016

Aziz Ari Kenan Buyukasik Ozgur Segmen Onder Akkus Cihad Tatar

https://doi.org/10.5455/umj.20160226125754

Abstract

Introduction: Over the years, with advances in minimally invasive surgery, laparoscopic TME has been more widely performed for the surgical treatment of rectal cancer. In addition to the well known advantages of laparoscopic surgery, there is also evidence that it is not oncologically inferior to open approach in the management of colorectal cancers. In the present study, we discuss our results for lymph node yield in laparoscopic total mesorectal excision for the malignant diseases of the rectum and the sigmoid colon. Method: We retrospectively collected the data from laparoscopic operations for malignant diseases of the rectum and the sigmoid colon. All laparoscopic anterior resection, low anterior resection and abdominoperineal resection procedures performed between 2009 and 2015 in the Istanbul Training and Research Hospital General Surgery Clinic were included. The results were analyzed and compared with the literature. Results: A total of 75 laparoscopic procedures for sigmoid colon and rectum cancers were performed in our clinic. The average lymph node yield was 17.5 ±8.4 and average metastatic lymph node was 2.4 ±3.4 . There was a positive correlation between lymph node yield and tumor size. Conclusion: In conclusion, laparoscopic TME is a valid option for the treatment of colorectal cancers. In addition to the universal benefits of minimally invasive surgery, laparoscopic approach allows extensive lymph node dissection, addressing oncological concerns surrounding the technique.

Keywords

Colorectal cancer, Lymph nodes, Laparoscopy, Total mesorectal excision

References

• Boutros M, Hippalgaonkar N, Silva E, Allende D, Wexner SD, Berho M. Laparoscopic Resection of Rectal Cancer Results in Higher Lymph Node Yield and Better Short-term Outcomes Than Open Surgery: A Large Single-Center Comparative Study. Dis Colon Rectum 2013;56:679-88
• Pechlivanides G, Gouvas N, Tsiaoussis J. Lymph Node Clearance after Total Mesorectal Excision for Rectal Cancer: Laparoscopic versus Open Approach. Dig Dis 2007;25:94-9.
• Leung KL, Kwok SP, Lam SC. Laparoscopic resection of rectosigmoid carcinoma: Prospective randomised trial. Lancet 2004; 363:1187-92.
• Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V. Laparoscopic resection in rectal cancer patients:outcome and cost-benefit analysis. Dis Colon Rectum 2007;50:464-71.
• Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 2008;15:2418-25.
• Ng SS, Lee JF, Yiu RY. Laparoscopic –assisted versus open total mesorectal excision with anal sphincter preservation for mid and low rectal cancer: a prospective, randomised trial. Surg Endosc 2014;28:297-306.
• Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW. Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 2003;46:1047-53.
• Bretagnol F, Lelong B, Laurent C. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg Endosc 2005;19:892-6.
• Morino M, Allaix ME, Giraudo G, Corno F, Garrone C. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Ann Surg 2005;242:897-901.
• Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 2006;49:1108-15.
• Lelong B, Bege T, Esterni B. Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 2007;50:176-83.
• Staudacher C, Vignali A, Saverio DP, Elena O, Andrea T. Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer: impact on early outcome. Dis Colon Rectum 2007;50:1324-31.
• Dural AC1, Keskin M, Balik E, Akici M, Kunduz E, Yamaner S, Asoglu O, Gulluoglu M, Bugra D. The role of the laparoscopy on circumferential resection margin positivity in patients with rectal cancer: long-term outcomes at a single high-volume institution. Surg Laparosc Endosc Percutan Tech 2015 Apr;25(2):129-37.