Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2021; 27(24): 3654-3667
Published online Jun 28, 2021. doi: 10.3748/wjg.v27.i24.3654
Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer
Hui-Hong Jiang, Hai-Long Liu, A-Jian Li, Wen-Chao Wang, Liang Lv, Jian Peng, Zhi-Hui Pan, Yi Chang, Mou-Bin Lin
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 Hospital, Tongji University School of Medicine, Shanghai 200090, China
Hui-Hong Jiang, Hai-Long Liu, Yi Chang, Mou-Bin Lin, Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China
Author contributions: Lin MB conceived the study and was the corresponding author; Jiang HH, Liu HL, Li AJ and Wang WC performed the study; Lv L, Peng J and Pan ZH helped collect the data; Liu HL and Chang Y analyzed and interpreted the data; Jiang HH drafted the manuscript; Jiang HH and Liu HL shared first co-authorship.
Supported by The National Natural Science Foundation of China, No. 81874201.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Yangpu Hospital, Tongji University School of Medicine, No. LL-2020-KXJS-004.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mou-Bin Lin, MD, Surgeon, Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, No. 450 Tengyue Road, Shanghai 200090, China. 1500142@tongji.edu.cn
Received: December 15, 2020
Peer-review started: December 15, 2020
First decision: January 6, 2021
Revised: January 20, 2021
Accepted: February 24, 2021
Article in press: February 24, 2021
Published online: June 28, 2021
Abstract
BACKGROUND

The procedure for lateral lymph node (LLN) dissection (LLND) is complicated and can result in complications. We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.

AIM

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 described. Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC, and their clinical data were analyzed.

RESULTS

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. Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients. The median operating time, blood loss and postoperative hospitalization were 178 (152-243) min, 55 (25-150) mL and 10 (7-20) d, respectively. The median number of harvested LLNs was 8.6 (6-12), and pathologically positive LLN metastasis was confirmed in 7 (35.0%) cases. Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.

CONCLUSION

Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible, effective and safe procedure for treating LALRC.

Keywords: Locally advanced low rectal cancer, Lateral lymph node dissection, Fascial anatomy, Visceral fascia, Vesicohypogastric fascia, Cardinal ligament

Core Tip: The procedure for lateral lymph node dissection (LLND) is complicated, with a high incidence of complications. We developed a technique of laparoscopic LLND based on two fascial spaces to simplify the procedure. By cadaveric dissection, we found that urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side and formed two spaces (Latzko's pararectal space and paravesical space) which were the surgical area for LLND. 3D-Laparoscopic LLND in two fascial spaces was performed successfully in 20 patients with locally advanced low rectal cancer, and the results showed that it was a feasible, effective and safe procedure.