Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery

1999 ◽  
Vol 384 (4) ◽  
pp. 405-406 ◽  
Author(s):  
F. Stelzner
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Radical Resection ◽  
Autonomic Nerve ◽  
Lower Rectal Cancer ◽  
Rectal Cancer Surgery ◽  
Node Dissection ◽  
Nerve Preservation ◽  
Autonomic Nerve Preservation ◽  
Dissection Techniques

Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer

2001 ◽  
Vol 193 (5) ◽  
pp. 579-584 ◽  
Author(s):  
Ichiro Uyama ◽  
Atsushi Sugioka ◽  
Hideo Matsui ◽  
Junko Fujita ◽  
Yoshiyuki Komori ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Autonomic Nerve ◽  
Lower Rectal Cancer ◽  
Node Dissection ◽  
Lateral Node ◽  
Nerve Preservation ◽  
Autonomic Nerve Preservation ◽  
Lateral Node Dissection

scholarly journals Autonomic nerve preservation in rectal cancer surgery - the forgotten part of the TME message a practical "workshop" description for surgeons

2008 ◽  
Vol 55 (3) ◽  
pp. 11-16 ◽  
Author(s):  
B. Heald
Keyword(s):  
Rectal Cancer ◽  
Cancer Surgery ◽  
Autonomic Nerve ◽  
Rectal Cancer Surgery ◽  
Autonomic Nerves ◽  
Nerve Preservation ◽  
Lateral Ligaments ◽  
Original Hypothesis ◽  
Autonomic Nerve Preservation ◽  
Cancer Spread

Conceptually TME has its basis in embryology. The original hypothesis was that cancer spread will tend, initially at least, to remain within the embryologic lymphovascular hindgut "envelope" the mesorectum and mesocolon. The corollary to the perfect specimen and cure is the perfect preservation of the layers surrounding the mesorectum which, are formed by the autonomic nerves and plexuses. The first obstacle is that few realistic photographs, sketches or diagrams have been published and visualisation and lighting low down in the pelvis is always problematic. Even when they are understood and visualised the difficulties inherent in preserving these nerves are due to the fact that they are actually adherent to the mesorectum at certain points where the dissection becomes particularly challenging. The most important and most adherent areas are the so-called "lateral ligaments" - low down laterally and anterolaterally where the inferior hypogastric plexuses (virtually the pelvic sex-brain) tether the whole mesorectal package. When the specimen has been carefully released it lifts up in a somewhat spectacular fashion - hence the old idea that there are ligaments at these points. A lesser degree of adherence may be found at various other points and particular care is required anteriorly where the nerves are converging towards the bulb of the penis with a trapezoidal septum between them - Denonvillier?s "fascia"- which is in turn adherent to the anterior mesorectum and lower down in the prostate.

scholarly journals Exploratory analysis of lateral pelvic sentinel lymph node status for optimal management of laparoscopic lateral lymph node dissection in advanced lower rectal cancer without suspected lateral lymph node metastasis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Yasui ◽  
Masayuki Ohue ◽  
Shingo Noura ◽  
Norikatsu Miyoshi ◽  
Yusuke Takahashi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Lower Rectal Cancer ◽  
Rectal Cancer Surgery ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Rectal Cancers ◽  
Lateral Pelvic Lymph Nodes

Abstract Background Total mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiotherapy (RT) are standard treatment for lower cT3/4 rectal cancers in Eastern countries. In comparative studies, both TME + LLND and RT + TME yield good local control. Although Japanese guidelines recommend LLND for locally advanced rectal cancers below the peritoneal reflection, LLND dissection of clinically negative lateral pelvic lymph nodes (LPLN) is controversial, and laparoscopic TME + LLND is technically challenging and time-consuming. New optical instruments for laparoscopy allow easy perioperative sentinel lymph node (SLN) identification using ICG. The SLN concept may facilitate accurate diagnosis of LPLN involvement, and thus reduce LLND in laparoscopic rectal cancer surgery. Here we investigated lateral pelvic SLN navigation surgery for SLN detection during laparoscopic rectal cancer surgery. Methods This study included 21 patients with clinical StageII/III lower rectal cancer without LPLN enlargement, who underwent curative laparoscopic surgery. All patients underwent TME, followed by lateral SLN identification and biopsy using ICG, and then laparoscopic LLND. ICG fluorescence imaging was conducted using the laparoscopic near-infrared camera system. Results Lateral SLNs were successfully identified in 16 (76.2%) of the 21 patients. Among the 15 patients without SLN tumor metastasis, the dissected lateral non-SLNs were all negative. Conclusions A lack of metastasis in the lateral pelvic SLN seems to reflect a lack of metastases to all lateral LNs. Our present results suggest that this laparoscopic ICG-guided SLN strategy may be a low-risk and time-saving method to prevent laparoscopic LLND in cases with negative lateral pelvic lymph nodes.

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