Laparoscopic Lateral Pelvic Lymphadenectomy in Rectal Neoplasia With Involvement of the Iliac Lymph Node Chain – Indications
Year: 2024
Type: article
Study design: Case Report
Abstract: Case Presentation A 52-year-old female patient, asymptomatic, with no comorbidities or family history of colorectal cancer (CRC). Screening colonoscopy revealed a subepithelial lesion, sessile, firm, 2.5 cm in size, with no elevation upon injection. Endoscopic ultrasound showed a lesion 7 cm from the anal margin, homogeneous, measuring 1.5x1.3 cm, involving the deep mucosal and submucosal layers. Pathology confirmed a well-differentiated neuroendocrine tumor, low histological grade, extending to the lamina propria, Ki67 positive. No distant metastases were found, and pelvic MRI showed an oval image of 2.6x2.0 cm in the mesorectum, maintaining contact with the mesorectal fascia, along with a lateral pelvic lymph node (LLN) in the left iliac chain measuring 1.9x1.4 cm. PET-CT (somatostatin analog) showed a hypercapturing lesion in the rectal wall, 4 cm from the anorectal transition, measuring 1.4 cm with increased uptake (observed on MRI). After multidisciplinary discussion, total mesorectal excision with lateral pelvic lymphadenectomy, colorrectal anastomosis, and temporary ileostomy was indicated. The surgical specimen had an intact mesorectum. The lateral lymph nodes were separately directed to the pathology department by the surgeon, and the specimens were marked. Due to the preservation of structures, it was possible to compare MRI images with the anatomical specimen sections, ensuring accurate identification of positive lymph nodes. Pathology confirmed a pT2pN1 tumor with metastases found in mesorectal lymph nodes (5/29) and lateral lymph nodes (1/11). Discussion Pelvic lateral lymph nodes >6.8 mm may require dissection before radiotherapy and chemotherapy. The literature supports that lateral pelvic lymph nodes (LLP) ≥5 mm after neoadjuvant therapy were strongly associated with pathological positivity, and subsequent dissection of these nodes resulted in no recurrence in the lateral compartment of treated patients. In terms of surgical technique, laparoscopy proved superior in the number of lymph nodes retrieved compared to laparotomy. There was no significant difference between robotic and laparoscopic groups regarding oncological outcomes and postoperative complications; however, robotic surgery showed shorter hospitalization times. Conclusion Cancer can be eradicated in over 30% of patients with positive lateral pelvic lymph nodes (LLP). The decision to perform lateral lymph node dissection will depend on the size and characteristics of these nodes on imaging exams. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Source: Journal of Coloproctology
Authors: Euler de Medeiros Azaro Filho, Rafaella Alcântara Alves Melo, Thamy Cristine Santana Marques, Mayara Maraux Maranhão, Flávia de Castro Ribeiro Fidelis, Lina Maria Góes de Codes, Elias Luciano Quinto de Souza, Euler de Medeiros Azaro Filho
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4409792199