Fascia- vs vessel-oriented lateral lymph node dissection for rectal cancer: Short-term outcomes and prognosis in a single-center experience

Wei Zhao; Zhi-Jie Wang; Shi-Wen Mei; Jia-Nan Chen; Si-Cheng Zhou; Fu-Qiang Zhao; Ti-Xian Xiao; Fei Huang; Qian Liu

doi:10.4240/wjgs.v15.i6.1080

Fascia- vs vessel-oriented lateral lymph node dissection for rectal cancer: Short-term outcomes and prognosis in a single-center experience

World J Gastrointest Surg. 2023 Jun 27;15(6):1080-1092. doi: 10.4240/wjgs.v15.i6.1080.

Authors

Wei Zhao¹, Zhi-Jie Wang¹, Shi-Wen Mei¹, Jia-Nan Chen¹, Si-Cheng Zhou¹, Fu-Qiang Zhao¹, Ti-Xian Xiao¹, Fei Huang¹, Qian Liu²

Affiliations

¹ Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. liuqncc@foxmail.com.

Abstract

Background: For the management of lateral lymph node (LLN) metastasis in patients with rectal cancer, selective LLN dissection (LLND) is gradually being accepted by Chinese scholars. Theoretically, fascia-oriented LLND allows radical tumor resection and protects of organ function. However, there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND. Through a preliminary study with a small sample size, we found that fascia-oriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs. In this study, we increased the sample size and refined the postoperative functional outcomes.

Aim: To compare the effects of fascia- and vessel-oriented LLND regarding short-term outcomes and prognosis.

Methods: We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021. The short-term outcomes included perioperative outcomes and postoperative functional outcomes. The prognosis was measured based on overall survival (OS) and progression-free survival (PFS).

Results: A total of 105 patients were included in the final analysis and were divided into fascia- and vessel-oriented groups that included 41 and 64 patients, respectively. Regarding the short-term outcomes, the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group. There were no significant differences in the other short-term outcomes. The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group. In addition, there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups. In terms of prognosis, there was no significant difference in PFS or OS between the two groups.

Conclusion: It is safe and feasible to perform fascia-oriented LLND. Compared with vessel-oriented LLND, fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.

Keywords: Fascia anatomy; Lateral lymph nodes; Lymph node excision; Prognosis; Rectal cancer; Treatment outcome.