Lateral pelvic lymph node dissection following neoadjuvant therapy in rectal cancer: Evaluation of morbidity, pathological and short-term oncological outcomes

ABSTRACT Objectives: In stage II-III low rectal cancer patients, the objectives of this study are evaluation of factors affecting involvement of lateral pelvic nodes, evaluation of pathological and short term oncological outcomes of selective lateral pelvic lymph node dissection in addition to total mesorectal excision following neoadjuvant therapy, evaluation of the effect of selective lateral pelvic lymph node dissection over perioperative morbidity and urinary functions. Patients and Methods: Between September 2011-May 2013, 35 patients (25 male, 10 female, male/female: 2,5/1, range of age: 39-79, mean age: 56,7) admitted to Bezmialem Vakif University School of Medicine General Surgery Department were randomised and included in this study. All patients had neoadjuvant chemoradiotherapy. Patients were divided into two groups according to admission order. Group 1 refers patients who had total mesorectal excision + lateral pelvic lymph node dissection (TME+LPLND) and Group 2 refers patients who had total mesorectal excision (TME). Involvement of lateral pelvic nodes, factors affecting involvement, morbidity, urinary functions and short term oncological outcomes were evaluated between two groups. Results: Intraoperative bleeding (ml) and operation time (min) were higher in LPLND group (bleeding: 297±168 vs 258±152; operation time: 249±55 vs 214±59). In group that LPLND was performed following neoadjuvant therapy (n=18), only 1 patient (%5,5) had LPLN involvement. No statistically significant difference were detected for morbidity, urinary functions and short term oncological outcomes between two groups. In MR imaging before neoadjuvant therapy, of patients who staged N2 (n=13), 61,5% (n=8) had radiologically involved LPLNs, of patients who staged N1 (n=16), 25% (n=4) had radiologically involved LPLNs. Conclusions: In MR imaging before neoadjuvant therapy, LPLND may not be beneficial for N0 patients. Besides, in N2 patient and selected N1 patients, LPLND may have potential to be beneficial.