Comparative study of oncologic efficacy of cephalomedial to lateral dissection versus medial to lateral dissection in laparoscopic total mesorectal excision for rectal cancer: An RCT study.
BACKGROUND AND OBJECTIVES
We compared the 3-year overall survival between cephalomedial-to-lateral approach proctectomy (CEMP) and medial-to-lateral approach proctectomy (MAP) in patients undergoing laparoscopic total mesorectal excision for rectal cancer. The advantages of CEMP and the clinical value of No. 253 lymph nodes resection have not been objectively analyzed in literature.


METHODS
This was a prospective, two-arm, multicenter, single-blinded, randomized trial. The primary endpoint was 3-year overall survival, and secondary endpoints included safety, feasibility, oncological radicality (including number of No. 253 lymph nodes harvested), short-term outcome, 3-year disease-free survival, rate of postoperative complications, mortality, and rate of recurrence.


RESULTS
From May 2016 to July 2020, 506 patients were enrolled-256 in the CEMP group and 250 in the MAP group. Comparison of overall survival and disease-free survival showed that there was treatment benefit in the CEMP group (28.22 ± 12.12 vs. 27.44 ± 13.06, p = 0.485; 27.24 ± 12.01 vs. 26.42 ± 12.81; p = 0.457). More No. 253 lymph nodes were harvested in the CEMP group, and cases with positive No. 253 lymph nodes had worse prognosis in stage III. Surgical safety was equal for both approaches.


CONCLUSIONS
Dissection of No. 253 lymph nodes may be important to improve clinical prognosis, but further studies with larger samples are needed to confirm this finding.
['Hong|Hi-Ju|HJ|', 'Zhao|Xuan|X|', 'Yu|Chao-Ran|CR|http://orcid.org/0000-0003-4657-7975', 'Sun|Jing|J|', 'Dong|Feng|F|', 'Zang|Lu|L|', 'Lu|Ai-Guo|AG|http://orcid.org/0000-0003-4028-0644', 'Feng|Bo|B|', 'Wang|Ming-Liang|ML|', 'Yu|Min-Hao|MH|', 'Qiu|Zheng-Jun|ZJ|', 'Qian|Bi-Yun|BY|', 'Xie|Li|L|', 'Fingerhut|Abe|A|', 'Zheng|Min-Hua|MH|https://orcid.org/0000-0002-9536-8793', 'Ma|Jun-Jun|JJ|', 'Zhong|Min|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D018572:Disease-Free Survival D005260:Female D005500:Follow-Up Studies D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D011184:Postoperative Period D000078542:Proctectomy D011446:Prospective Studies D012004:Rectal Neoplasms D016896:Treatment Outcome D055815:Young Adult
laparoscopic total mesorectal excision rectal cancer no. 253 lymph node postoperative complication laparoscopy surgery