低位直肠癌新辅助放化疗后腹腔镜侧方淋巴结清扫术(附视频)

Laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after neoadjuvant chemoradiation

侧方淋巴转移是导致中低位直肠癌术后局部复发的重要原因。尽管目前尚无随机对照研究证实常规侧方淋巴结清扫的长期获益,但回顾性的研究显示其能有效地降低侧方淋巴结转移患者的局部复发率,提高生存率。近期,我们对术前影像学可疑侧方淋巴结转移的中低位c T3/4直肠癌患者给予新辅助放化疗后行腹腔镜全直肠系膜切除术手术,再根据侧方淋巴结肿大情况加做选择性单侧或双侧侧方淋巴结清扫。该术式是安全可行的,并取得了良好的近期效果。本文就此进行论述。

Lateral pelvic lymph node metastasis was an major cause of locoregional recurrence of mid-low rectal cancer. Although long-term beneift of routine lateral lymph node dissection has not been proved by randomized controlled trial, retrospective studies have shown its efficacy in lowering local recurrence and increasing survival rate in patients with lateral lymph node metastasis. Recently, laparoscopic total mesorectal excision surgery was performed in patients with advanced low rectal cancer, followed by selective unilateral or bilateral lateral lymph node dissection based on pretreatment imaging after preoperative chemoradiation. This technique is safe and feasible with favorable short-term results. We will discuss it in this paper.