Objective By comparing its perioperative outcomes with that of conventional open surgery, this study was to determine the feasibility and safety of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision (TME) for mid-low rectal cancer.

Methods We retrospectively analyzed clinical records of 16 patients underwent laparoscopic surgery and 55 patients treated with open surgery at Zhejiang Cancer Hospital during the same period. Perioperative outcomes such as operative time, intraoperative blood loss, number of lateral lymph node harvested, postoperative complications and length of hospital stay after surgery were compared between the two groups.

Results Laparoscopic and open surgery groups had similar baseline clinical features. No laparoscopic patients were converted to open surgery. No patients died during the perioperative period. Compared with the open surgery group, the laparoscopic group had significantly longer operative time(218.6±71.6 min vs. 181.3±57.9 min, P=0.035), but less intraoperative blood loss(190.6±80.1 ml vs. 344.9±295.2 ml, P=0.044). There was no significant difference between laparoscopic and open surgery groups in the length of hospital stay after surgery(10.9±3.5 days vs. 13.8±7.1 days, P=0.125), the rates of postoperative complications (25.0% vs. 20.0%, P=0.666), the mean numbers of harvested lateral lymph nodes(9.8±6.1 vs. 11.0±9.7, P=0.642) and lateral lymph node metastasis rates(25.0% vs. 34.5%, P=0.556). Lateral lymph node metastasis was significantly associated with tumor differentiation(P=0.001), intravascular tumor emboli(P=0.011) and neural infiltration(P=0.002), but not with preoperative chemoradiotherapy(P=0.479) or tumor size(P=0.907).

Conclusion Laparoscopic lateral lymph node dissection following TME for mid-low rectal cancer is feasible and safe. It could achieve the same perioperative clinical outcomes as conventional open surgery.