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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
Author(s) -
Hong HiJu,
Zhao Xuan,
Yu ChaoRan,
Sun Jing,
Dong Feng,
Zang Lu,
Lu AiGuo,
Feng Bo,
Wang MingLiang,
Yu MinHao,
Qiu ZhengJun,
Qian BiYun,
Xie Li,
Fingerhut Abe,
Zheng MinHua,
Ma JunJun,
Zhong Min
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26425
Subject(s) - medicine , total mesorectal excision , dissection (medical) , colorectal cancer , clinical endpoint , surgery , lymph , stage (stratigraphy) , randomized controlled trial , lymph node , laparoscopy , prospective cohort study , survival rate , clinical trial , cancer , pathology , paleontology , biology
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.