Comparison of the effect of lateral lymph node dissection in descending rectal cancer by two anatomic approaches

doi:10.3877/cma.j.issn.1674-3946.2025.01.012.

Abstract

Abstract:

Objective

To compare the effect of two anatomical approaches in lateral lymph node dissection of rectal cancer.

Methods

Clinical data of 123 patients with rectal cancer who underwent total mesorectal resection from January 2019 to January 2022 and completed 3-year follow-up were retrospectively collected.According to different anatomical approaches of lateral lymph node dissection， 60 patients were divided into fascia group （fascia-oriented anatomical approach） and 63 patients were divided into vascular group（vaso-oriented anatomical approach）.SPSS25.0 software was used to process the data.Surgical indicators， the number of lateral lymph nodes detected and other measurement data were expressed as （x± s）， and independent sample t test was performed.The positive lymph node detection rate and postoperative complication rate were analyzed by χ² test.Kaplan-Meier method and Log-Rank test were used for survival analysis， and P＜0.05 was considered statistically significant.

Results

There was no significant difference in intraoperative blood loss，operation time and hospital stay between the two groups （P＞0.05）.The number of lymph nodes detected in fascia group was higher than that in blood vessel group （P＜0.05）， and there was no significant difference in the positive lymph node detection rate between the two groups （P＞0.05）.The incidence of postoperative urinary dysfunction and sexual dysfunction in fascia group was lower than that in vascular group （P＜0.05）.Log-Rank test results showed that there was no significant difference in progression-free survival between the two groups during follow-up （P＞0.05）.

Conclusion

The positive lymph node detection rate and progression-free survival rate were similar between fascia-guided approach and vaso-guided approach in rectal cancer lateral lymph node dissection， but more lateral lymph nodes could be detected by fascia-guided approach， which could reduce the occurrence of postoperative urinary dysfunction and sexual dysfunction.

Key words: Rectal Neoplasms, Total Mesorectal Excision, Lateral Lymph Node Dissection, Fascia Guided Anatomical Approach, Vascular Guided Anatomical Approach

Hui Wu, Yongjun Nai, Xuesong Shi, Xiaowei Wei. Comparison of the effect of lateral lymph node dissection in descending rectal cancer by two anatomic approaches[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 40-43.

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Figures/Tables 6

组别	例数	性别（例）男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤距肛缘距离（cm， $\overset{ˉ}{x}$ ±s）	肿瘤T分期（例）T_0-2/T_3-4
筋膜组	60	33/27	59.2±3.3	5.1±1.4	14/46
血管组	63	30/33	58.5±3.4	5.1±1.3	20/43
t/χ²值		0.670	1.098	0.188	1.087
P值		0.413	0.274	0.851	0.297

组别	例数	性别（例）男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	肿瘤距肛缘距离（cm， $\overset{ˉ}{x}$ ±s）	肿瘤T分期（例）T_0-2/T_3-4
筋膜组	60	33/27	59.2±3.3	5.1±1.4	14/46
血管组	63	30/33	58.5±3.4	5.1±1.3	20/43
t/χ²值		0.670	1.098	0.188	1.087
P值		0.413	0.274	0.851	0.297

组别	例数	术中出血量（ml）	手术时间（min）	住院时间（d）
筋膜组	60	55.4±15.1	212.2±20.9	10.6±1.5
血管组	63	58.0±14.8	218.5±21.3	11.1±1.5
t值		0.970	1.656	1.617
P值		0.334	0.100	0.108

组别	例数	侧方淋巴结检出数量（枚， $\overset{ˉ}{x}$ ±s）	阳性淋巴结检出率［例（%）］
筋膜组	60	9.2±2.0	11（18.3）
血管组	63	7.5±2.2	17（27.0）
t/χ²值		4.493	1.308
P值		＜0.001	0.253

组别	例数	侧方淋巴结检出数量（枚， $\overset{ˉ}{x}$ ±s）	阳性淋巴结检出率［例（%）］
筋膜组	60	9.2±2.0	11（18.3）
血管组	63	7.5±2.2	17（27.0）
t/χ²值		4.493	1.308
P值		＜0.001	0.253

组别	例数	排尿功能障碍	性功能障碍	吻合口漏	切口感染
筋膜组	60	14（23.3）	20（33.3）	1（1.7）	2（3.3）
血管组	63	32（50.8）	39（61.9）	2（6.3）	4（6.3）
χ²值		9.898	10.052	0.294	0.602
P值		0.002	0.002	0.588	0.438

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