title: Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience.
abstract: OBJECTIVE
  To evaluate the technical feasibility, safety, and oncological outcomes of laparoscopic extended lateral pelvic lymph node dissection (LPLD) following total mesorectal excision (TME) in patients with advanced low rectal cancer.
  
  
  METHODS
  A review of a prospectively collected database at Kyungpook National University Hospital from May 2003 to September 2009 revealed a series of 16 consecutive laparoscopic TME with LPLD patients with preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, functional outcome, and mid-term oncologic result were analyzed.
  
  
  RESULTS
  In all 16 patients, the procedures were completed without conversion to open surgery. During the study period, robot-assisted laparoscopic LPLD was performed in two patients. Mean operative time was 321.9 min (range 220-510 min). The mean number of lateral lymph nodes harvested was 9.1 (range 3-19), and a total of nine patients (56.2%) had lymph node metastases. Postoperative mortality and morbidity were 0 and 31.2%, respectively. Recovery after the procedure was rapid, and mean hospital stay was 9.9 days (range 7-14 days). With median follow-up of 38 months, among nine patients who were lateral pelvic node positive, one patient experienced pelvic side-wall local recurrence (11.2%).
  
  
  CONCLUSIONS
  Laparoscopic TME with LPLD is safe and feasible, with the advantage of a minimally invasive approach. Prospective controlled study comparing laparoscopy and conventional open surgery with long-term follow-up evaluation is needed to confirm the authors' initial experience.
authors.affiliation: Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Kyoung Hoon
authors.initials: KH
authors.lastname: Lim
authors.forename: You Seok
authors.initials: YS
authors.lastname: Jang
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Soo Han
authors.initials: SH
authors.lastname: Jun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003952:Diagnostic Imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061214:Patient Safety; D010388:Pelvis; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome