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Multicenter Study
. 2025 Sep;32(9):6708-6719.
doi: 10.1245/s10434-025-17155-6. Epub 2025 May 8.

Evaluation of Short-Term Postoperative Outcomes of Lateral Lymph Node Dissection After Neoadjuvant Radiotherapy for Rectal Cancer Patients: The Early Learning Phase After Surgical Training in the Netherlands

Eline G M van Geffen  1   2 , Tsuyoshi Konishi  3 , Sanne-Marije J A Hazen  1   2 , Tania C Sluckin  1   2 , Charmaine M Tjin-A-Koeng  1 , Eric H J Belgers  4 , Johanna G Bloemen  5 , Esther C J Consten  6 , Rogier M P H Crolla  7 , Michalda S Dunker  8 , Klaas Havenga  9 , Christiaan Hoff  10 , Fatih Polat  11 , Maria Verseveld  12 , Karin Horsthuis  13 , Pieter J Tanis  14   15 , Miranda Kusters  16   17
Affiliations
Multicenter Study

Evaluation of Short-Term Postoperative Outcomes of Lateral Lymph Node Dissection After Neoadjuvant Radiotherapy for Rectal Cancer Patients: The Early Learning Phase After Surgical Training in the Netherlands

Eline G M van Geffen et al. Ann Surg Oncol. 2025 Sep.

Abstract

Background: Distal, locally advanced rectal cancer might spread to lateral lymph nodes (LLNs), posing a risk of lateral local recurrence (LLR). This study evaluated quality-controlled implementation of lateral lymph node dissection (LLND) in the Netherlands.

Methods: This retrospective multicenter cohort study included consecutively treated rectal cancer patients who underwent neoadjuvant therapy, total mesorectal excision (TME) surgery, and nerve-sparing minimally invasive LLND by trained surgeons across 10 Dutch hospitals. Training involved cadaver sessions, monthly video meetings, and proctoring. Outcome measures included intra- and postoperative complications, urogenital dysfunction and 18-month LLR, local recurrence (LR), and disease-free survival (DFS).

Results: The study comprised 41 patients (median follow-up period, 16 months; interquartile range, IQR, 8-21 months) with advanced tumors (27% cT4, 49% cN2, 7% cM1), and a mean LLN size of 11 mm on primary-staging MRI. Abdominoperineal resection was performed for 29 patients (70%). A beyond TME procedure was performed for 11 patients (28%). The median blood-loss was 250 ml (IQR, 100-400 ml), with obturator nerve injury reported in one patient. Malignant LLNs were found in 41% of the LLND specimens. Complications occurred for 22 patients (54%), 21% (9/41) of which were grade 3 or higher. Nine patients (22%, four of whom underwent beyond TME surgery) had a Foley or intermittent urinary catheter at the end of the follow-up period. Sexual dysfunction of three patients was reported. No ipsilateral LLRs occurred. The 18-month LR rate was 14%, and the DFS was 55%.

Conclusion: Minimally invasive nerve-sparing LLND by trained Dutch surgeons showed acceptable complication rates and good oncologic control of the lateral compartment to date.

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Conflict of interest statement

Disclosure: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Intraoperative images of robot-assisted lateral lymph node dissection. A Overview of the lateral compartment during dissection of obturator lymph nodes. B The medial plane of lateral lymph node dissection as indicated by the umbilical artery and the vesicohypogastric fascia. C Overview of the lateral compartment after dissection of the internal iliac and obturator lymph nodes.
Fig. 2
Fig. 2
Survival outcomes. A The 18-month local recurrence rate is 14%. B The 18-month distant metastases rate is 39%. C The 18-month overall survival rate is 85%. D The 18-month disease-free survival rate is 55%.
Fig. 3
Fig. 3
Flowchart of patient selection
See this image and copyright information in PMC

References

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