To investigate the application value of neoadjuvant long-term simultaneous chemoradiotherapy total mesorectal resection (TME) + lateral lymph node dissection (LLND) for locally advanced low rectal cancer with lateral lymph node diameter <10 mm.

A total of 126 patients with locally advanced low rectal cancer from June 2018 to June 2021 were prospectively selected and divided into two groups according to random number table method, with 63 patients in each group. The control group received neoadjuvant long-course concurrent chemoradiotherapy +TME, and the observation group received LLND on the basis of the control group. SPSS 24.0 was used to complete the data analysis. Measurement data such as perioperative indicators were represented by (), and independent sample t test was used between groups. The statistical data of postoperative complications were tested by χ². Kaplan-Meier test and Log-Rank test were used to analyze the prognosis of the two groups. P<0.05 was considered statistically significant.

The operative time of observation group was significantly longer than that of control group, and the amount of intraoperative blood loss and the total number of lymph node dissection were higher than those of control group, the difference was statistically significant (P<0.05). There were no significant differences in maximum urine volume, bladder residual urine volume, International erectile function index (IIEF) score and total incidence of postoperative complications between 2 groups (P>0.05). The median follow-up time was 31 months. The cumulative disease-free survival rate in observation group was significantly higher than that in control group (74.6% vs. 58.7%), with statistical significance (Log-Rank χ²=4.628, P=0.036). The cumulative overall survival rate of the two groups was 77.8% and 63.5%, and there was no significant difference between the two groups (Log-Rank χ²=2.984, P=0.077).

Compared with nCRT+TME alone in the treatment of locally advanced low rectal cancer, although the intraoperative combination with lateral lymph node dissection increased the operative time and intraoperative bleeding, it could effectively control postoperative local recurrence without increasing the incidence of complications, which has positive clinical significance.