Feasibility of laparoscopic D3 lymphadenectomy for male rectosigmoid cancer with clinically positive lymph nodes.

Background: Laparoscopic D3 lymphadenectomy is a challenging surgical procedure and has not been reported before. The present study aimed to test the technical feasibility of this procedure.

Methods: Fifty-four consecutive male patients with clinically staged III rectosigmoid cancer were recruited to undergo laparoscopic D3 lymph node dissection. The extent of the D3 lymphadenectomy of rectosigmoid cancer included skeletonization of bilateral common iliac arteries and veins and abdominal aorta upwards to the level of the duodenal third portion and left renal vein, in addition to the mesenteric dissection in the standard anterior resection. The patients were prospectively followed for surgical feasibility, efficiency, and outcomes.

Results: Laparoscopic D3 lymphadenectomy for rectosigmoid cancer was performed with acceptable operation time (303.4 +/- 35.8 min, mean +/- standard deviation) and moderate blood loss (344.8 +/- 50.6 ml) through small wounds. There was no mortality within 30 days after operation and the complication rate was acceptable (20.4%). The patients has quick functional recovery, as evaluated by the restoration of flatus passage (60.4 +/- 12.4 h), hospitalization (11.0 +/- 1.5 days), and the degree of postoperative pain (3.5 +/- 0.6, visual analogue scale). D3 lymphadenectomy resulted in the harvest of ample lymph nodes (24.6 +/- 4.5) for histopathological examinations and facilitated the upstaging of three (5.6%) patients.

Conclusion: D3 lymph node dissection by the laparoscopic approach can be safely and efficiently performed for male rectosigmoid cancer with quick convalescence.