<strong>Abstract</strong> <em>Introduction: </em>There are controversies over the treatment options for pelvic lymph node metastasis in low rectal cancer. The role of neoadjuvant radiotherapy in radical treatment of pelvic lymph node metastasis is still unidentified. Total mesorectal excision (TME) with Laparoscopic pelvic lymph node dissection (LPLND) provides lower pelvic recurrence in 5 years than TME only. <em>Material and Methods: </em>Prospective, uncontrolled clinical trial for patients with low rectal cancer (below peritoneal fold), who had suspected lateral pelvic lymph node metastasis on MRI scan and the patients did not have contraindication for laparoscopic surgery. <em>Result: </em>From January 2017 to February 2018 we performed 12 cases of LPLND. There was no con-version to open surgery. The average time for lymphadenectomy is 75 minutes with an average amount of blood loss of 97ml. Only 1 case had postoperative urinary retention (8%). The rate of pos-itive pelvic node was 5.8%, with an average of resected nodes of 4.9 nodes. Lymph nodes size on MRI scan in the positive pelvic node group was 20.6mm, compared to 7mm in the negative group. <em>Conclusion: </em>Laparoscopic lateral pelvic lymph node dissection is a feasible and safe technique and should be done by experienced colorectal surgeons. Aging, female sex and pelvic lymph node size on MRI are related to pelvic lymph node metastasis. <strong>Keyword: </strong>Pelvic lymph node dissection; Laparoscopic surgery; Management of low rectal cancers. <strong>References</strong> <ol> <li>Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. The Lancet Oncology. 2012;13(6):616-21. doi: 10.1016/S1470-2045(12)70158-4.</li> <li>Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Annals of surgical oncology. 2014;21(1):189-96. doi: 10.1245/s10434-013-3216-y.</li> <li>Kim MJ, Kim TH, Kim DY, Kim SY, Baek JY, Chang HJ, et al. Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? Journal of surgical oncology. 2015;111(4):459-64. doi: 10.1002/jso.23852.</li> <li>Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, et al. Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/ III Lower Rectal Cancer (JCOG0212): A Multicenter, Randomized Controlled, Noninferiority Trial. Annals of surgery. 2017;266(2):201-7. doi: 10.1097/ SLA.0000000000002212.</li> <li>Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, et al. Laparoscopic versus open total mesorectal excision for rectal cancer. The Cochrane database of systematic reviews. 2014;(4):CD005200. doi: 10.1002/14651858.CD005200.pub3.</li> <li>Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K, et al. Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Annals of surgery. 2012;255(6):1129-34. doi: 10.1097/SLA.0b013e3182565d9d.</li> <li>Kim MJ, Hur BY, Lee ES, Park B, Joo J, Kim MJ, et al. Prediction of lateral pelvic lymph node metastasis in patients with locally advanced rectal cancer with preoperative chemoradiotherapy: Focus on MR imaging findings. PloS one. 2018;13(4):e0195815. doi: 10.1371/ journal.pone.0195815.</li> <li>Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Annals of surgical oncology. 2008;15(3):729-37. doi: 10.1245/s10434-007-9696-x.</li> <li>Akiyoshi T, Matsueda K, Hiratsuka M, Unno T, Nagata J, Nagasaki T, et al. Indications for Lateral Pelvic Lymph Node Dissection Based on Magnetic Resonance Imaging Before and After Preoperative Chemoradiotherapy in Patients with Advanced Low-Rectal Cancer. Annals of surgical oncology. 2015;22 Suppl 3:S614-20. doi: 10.1245/s10434-015-4565-5.</li> <li>Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(1):34-43 doi: 10.1200/JCO.2012.45.3258.</li> <li>Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Diseases of the colon and rectum. 2006;49(11):1663-72. doi: 10.1007/ s10350-006-0714-z.</li> <li>Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. International journal of clinical oncology. 2015;20(2):207-39. doi: 10.1007/ s10147-015-0801-z.</li> <li>Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, et al. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. The Lancet Oncology. 13(6):616-21. doi: 10.1016/ S1470-2045(12)70158-4.</li> <li>Akiyoshi T. Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer. World journal of gastroenterology. 2016;22(2):718-26. doi: 10.3748/wjg. v22.i2.718.</li> <li>Liang JT. Technical feasibility of laparoscopic lateral pelvic lymph node dissection for patients with low rectal cancer after concurrent chemoradiation therapy. Annals of surgical oncology. 2011;18(1):153-9. doi: 10.1245/s10434-010-1238-2.</li> <li>Konishi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Akiyoshi T, et al. Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surgical endoscopy. 2011;25(7):2358-9. doi: 10.1007/s00464-010-1531-y.</li> <li>Park JS, Choi GS, Lim KH, Jang YS, Kim HJ, Park SY, et al. Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience. Surgical endoscopy. 2011;25(10):3322-9. doi: 10.1007/ s00464-011-1719-9.</li> <li>Liu T, Zhang C, Yu P, Chen J, Zeng D, Gan L, et al. Laparoscopic radical correction combined with extensive lymphadenectomy and pelvic autonomic nerve preservation for mid-to-low rectal cancer. Clinical colorectal cancer. 2011;10(3):183-7. doi: 10.1016/j.clcc.2011.03.025.</li> <li>Obara S, Koyama F, Nakagawa T, Nakamura S, Ueda T, Nishigori N, et al. Laparoscopic lateral pelvic lymph node dissection for lower rectal cancer: initial clinical experiences with prophylactic dissection. Gan to kagaku ryoho Cancer & chemotherapy. 2012;39(12):2173-5.</li> <li>Bae SU, Saklani AP, Hur H, Min BS, Baik SH, Lee KY, et al. Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series. Annals of surgical treatment and research. 2014;86(2):76-82. doi: 10.4174/ astr.2014.86.2.76.</li> <li>Furuhata T, Okita K, Nishidate T, Ito T, Yamaguchi H, Ueki T, et al. Clinical feasibility of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision for advanced rectal cancer. Surgery today. 2015;45(3):310-4. doi: 10.1007/s00595-014-0906-4.</li> <li>Kagawa H, Kinugasa Y, Shiomi A, Yamaguchi T, Tsukamoto S, Tomioka H, et al. Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surgical endoscopy. 2015;29(4):995-1000. doi: 10.1007/s00464-014-3760-y.</li> </ol> <!--more--> <a href="https://vjsel.com/wp-content/uploads/2021/02/SỐ-4-TẬP-9-2019-chot-In-21-36.pdf">Download PDF File</a>