Total Mesorectal Excision with or without Lateral Pelvic Lymph Node Dissection in Rectal Cancer

Abstract

Backgrounds and Aims. The benefit of lateral pelvic lymph node dissection (LPLD) for rectal cancer remains controversial. The aim of this study was to assess the incidence of local recurrence between patients who underwent total mesorectal excision (TME) with and without LPLD in rectal cancer. Patients and Methods. The study was conducted on 92 patients presenting with extraperitoneal rectal cancer (T3 and T4) in the colorectal department at our hospital. Patients were divided into two groups: Group A was subjected to total mesorectal excision (TME) after neoadjuvant chemoradiation and Group B was subjected to TME with LPLD with autonomic nerve preservation. Patients were followed up for the incidence of local recurrence, distant recurrence, and urinary and sexual dysfunctions. Results. Incidence of local recurrence was slightly higher in Group A (8.7%) than in Group B (4.3%) but was not statistically significant. There was no statistical significance between both groups regarding distant metastasis (8.7% in Group A and 13% in Group B). Urinary and sexual dysfunctions were higher in Group B (26.1%) compared to those in Group A (21.7%) but were not statistically significant. The incidence of lateral pelvic lymph node metastasis was 30.4%. Also, intraoperative blood loss was higher and operative time was longer in Group B which was statistically significant ($P$ value <0.001). Conclusion. Our conclusion was that prophylactic addition of LPLD to TME was not associated with a statistically significant decrease in the risk of local recurrence or distant metastasis in patients with rectal cancer, although it was numerically better. LPLD is associated with longer operative time and higher intraoperative blood loss.