Clinical Significance Of Therapeutic Lateral Lymphadenectomy For Rectal Cancer Based On Rectal MR Imaging Guided Progressive Peritoneal Reentry

objective To evaluate the clinical value of therapeutic lateral lymph node dissection for advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy by rectal MR in patients with iliac perivascular lymph node enlargement(lymph node short diameter > 10mm)under peritoneal retroflexion.Methods Because of this study is A retrospective study,the propensity to evaluate matching group is adopted to the group A for A large medical center in January 2010 to December 2013 were 30 cases of rectum MR images after neoadjuvant chemoradiation weeks iliac blood vessels have the progress of the lymph node enlargement period under peritoneal fold return rectal cancer line TME + therapeutic cases of lateral lymph node cleaning;In group B,tendentious evaluation was performed to match 30 cases with the same tumor site,stage,type,gender and age as those in group A or similar,while only TME was performed in group B.The rate of pelvic autonomic nerve injury,two-year local recurrence rate and 5-year tumor-free survival rate were compared between the two groups,so as to explore the clinical value of periiliac perivascular dissection for advanced retroperitoneal rectal cancer.Results The local pelvic recurrence rates of group A and group B were 0(0/30)and 20%(6/30)respectively 2 years after surgery,with significant difference(P<0.05).Postoperative dysuria in group A and group B was 12.50%(8/30)and3.33%(1/30),respectively,with A significant difference(P<0.05).The 5-year survival rates of group A and group B were 53.33%(16/30)and 50.00%(15/30),respectively,with no significant difference(P > 0.05).The liver metastasis rates of group A and group B were 6.67%(2/30)and 6.67%(2/30),respectively.The lung metastasis rates in group A and group B were 46.67%(16/30)and 43.33%(13/30),respectively.Conclusion Advanced rectal cancer after neoadjuvant chemotherapy,according to the guidance of rectal magnetic resonance,selective treatment along the iliac blood vessels for the treatment of lymphatic dissection,can reduce the patient’s 2 years of pelvic local recurrence,but increase the probability of pelvic autonomic nerve injury,iliac perivascular lymph node dissection will not increase the 5-year survival rate of the case.