The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study

Introduction: Laparoscopic lateral lymph node dissection (LLND) is an important treatment for patients with lateral lymph node metastasis. Aim: To assess the technical feasibility and investigate the surgical outcomes after LLND using the fascia space priority approach for patients with advanced middle and low rectal cancer. Material and methods: Consecutive patients undergoing laparoscopic LLND using the fascia space priority approach from June 2017 to June 2020 were identified from 12 medical centres in mainland China. Three anatomic fascia spaces were dissected to establish the boundaries of the LLND, and the obturator and internal iliac lymph nodes were excised in an en bloc manner. Retrospective clinical data including patient characteristics, surgical details, and pathology were analysed. Results: A total of 112 patients were identified. All surgeries were completed laparoscopically with no conversions. The mean operation time was 343.6 +/- 103.8 min for the entire procedure. The median blood loss was 100 ml (range: 100-700 ml). The median lymph node yield was 6 (range: 1-41), and lymph nodes were positive in 39.3% (44/112) of the patients. Sixteen (14.3%) patients had Clavien-Dindo I-II complications, no Clavien-Dindo III-IV complications were identified. The incidence of complications between the bilateral dissection group and the unilateral dissection group was not statistically different (p = 0.19). The complication rate between the "nCRT" group and the "no nCRT" group was not significantly different (p = 0.62) either. There were no perioperative deaths. Conclusions: Laparoscopic LLND using the fascia space priority approach is feasible and safe for patients with lateral lymph node metastasis.