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Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer

World Journal of Gastroenterology 2021年第24期27卷 3654-3667页

作者： Hui-Hong Jiang Hai-Long Liu A-Jian Li Wen-Chao Wang Liang Lv Jian Peng Zhi-Hui Pan Yi Chang Mou-Bin Lin Department of General Surgery Yangpu HospitalTongji University School of MedicineShanghai 200090China Institute of Gastrointestinal Surgery and Translational Medicine Tongji University School of MedicineShanghai 200090China

BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in *** developed a technique for laparoscopic LLND based on two fascial spaces to simplify the *** To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and *** dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were *** The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for *** LLND in two fascial spaces was performed successfully in all 20 *** median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,*** median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)*** complications included lower limb pain in 1 case and lymph leakage in 1 *** Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.

关键词： Locally advanced low rectal cancer lateral lymph node dissection Fascial anatomy Visceral fascia Vesicohypogastric fascia Cardinal ligament

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Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

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World Journal of Gastroenterology 2020年第21期26卷 2877-2888页

作者： Jia-Nan Chen Zheng Liu Zhi-Jie Wang Shi-Wen Mei Hai-Yu Shen Juan Li Wei Pei Zheng Wang Xi-Shan Wang Jun Yu Qian Liu Department of Colorectal Surgery National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union CollegeBeijing 100021China Departments of Surgery the Johns Hopkins University School of MedicineBaltimoreMD 21218United States

BACKGROUND lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal *** chemoradiotherapy(NCRT)can effectively reduce the postoperative recurrence rate;thus,NCRT with total mesorectal excision(TME)is the most widely accepted standard of care for rectal *** addition of lateral lymph node dissection(LLND)after NCRT remains a controversial *** To investigate the surgical outcomes of TME plus LLND,and the possible risk factors for lateral lymph node metastasis after *** This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October *** the NCRT group,TME plus LLND was performed in patients with short axis(SA)of the lateral lymph node greater than 5 *** the non-NCRT group,TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 *** regarding patient demographics,clinical workup,surgical procedure,complications,and outcomes were *** logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT *** LLN metastasis was pathologically confirmed in 35 patients(39.3%):26(41.3%)in the NCRT group and 9(34.6%)in the non-NCRT *** most common site of metastasis was around the obturator nerve(21/35)followed by the internal iliac artery region(12/35).In the NCRT patients,46%of patients with SA of LLN greater than 7 mm were *** postoperative 30-d mortality rate was 0%.Two(2.2%)patients suffered from lateral local recurrence in the 2-year follow *** analysis showed that cT4 stage(odds ratio[OR]=5.124,95%confidence interval[CI]:1.419-18.508;P=0.013),poor differentiation type(OR=4.014,95%CI:1.038-15.520;P=0.044),and SA≥7 mm(OR=7.539,95%CI:1.487-38.214;P=0.015)were statistically significant risk factors associated with LLN metasta

关键词： Rectal neoplasms Neoadjuvant therapies lateral lymph node dissection Locoregional recurrence lymphatic metastasis Total mesorectal excision

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T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

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World Journal of Clinical Cases 2022年第33期10卷 12404-12409页

作者： Xian-Wei Liu Bing Zhou Xiao-Yu Wu Wen-Bing Yu Ren-Fang Zhu Department of General Surgery Jiujiang No.1 People’s HospitalJiujiang 332000Jiangxi ProvinceChina Department of Pathology Jiujiang No.1 People’s HospitalJiujiang 332000Jiangxi ProvinceChina

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal ***,LLNM is easily missed,especially in patients with early-stage rectal *** our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous *** SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal *** pathology report showed a diagnosis of T1 rectal mucinous *** was considered to have bilateral LLNM after the examination at our *** total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral *** patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up *** T1 rectal cancer could lead to LLNM and possibly,bilateral ***,adequate clinical evaluation is essential for these patients.

关键词： T1 rectal cancer lateral lymph node metastasis lateral lymph node dissection Brief literature review Endoscopic submucosal dissection Case report

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New classification system for radical rectal cancer surgery based on membrane anatomy

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1465-1473页

作者： Hui-Hong Jiang Zhi-Zhan Ni Yi Chang A-Jian Li Wen-Chao Wang Liang Lv Jian Peng Zhi-Hui Pan Hai-Long Liu Mou-Bin Lin Department of General Surgery Yangpu HospitalTongji University School of MedicineShanghai 200090China Institute of Gastrointestinal Surgery and Translational Medicine Tongji University School of MedicineShanghai 200090China

BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor ***,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical *** To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer *** A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical ***,we suggested a new and simple classification system for rectal cancer *** simplification,the classification was based only on the lateral extent of *** The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or *** types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve *** surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,*** Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing *** classification system may offer an optimal tool for tailoring rectal cancer surgery.

关键词： Radical rectal cancer surgery Classification system Membrane anatomy Total mesorectal excision lateral lymph node dissection

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