Fascial space priority approach in laparoscopy: lateral pelvic lymph node dissection for advanced low rectal cancer

Excerpt

Lateral lymph node dissection (LLND) is a routine procedure for advanced low rectal cancer management in Japan [1]. In contrast, preoperative chemoradiotherapy with total mesorectal excision (TME) is the standard treatment for advanced low rectal cancer in most western countries [2]. As evidenced by recent research, such an integrated approach has failed to prevent either metastasis or recurrence of lateral lymph nodes [3]. For cases with metastatic lymph nodes after chemoradiotherapy, LLND has been highly recommended [4]. However, due to the complexity of LLND and the possibility of complications, along with the increased difficulty of operation due to tissue edema and fibrosis after neoadjuvant therapy, the extensive development of this technique is limited [5]. We explore a fascial priority approach for laparoscopic LLND, which simplifies and standardizes the technique. The attached video demonstrates the process of LLND dissection after TME adopting the fascia space priority approach step by step. …