Fascia- vs vessel-oriented lateral lymph node dissection for rectal cancer: Short-term outcomes and prognosis in a single-center experience

Table 1 Baseline characteristics of the entire cohort (n = 105)

Variables	Fascia-oriented group (n = 41)	Vessel-oriented group (n = 64)	P value
Age (yr), median (IQR)	58.0 (48.0, 65.0)	58.5 (47.0, 65.0)	0.908
Sex, n (%)			0.728
Male	21 (51.2)	35 (54.7)
Female	20 (48.8)	29 (45.3)
BMI (kg/m2), median (IQR)	24.8 (21.6, 27.8)	24.2 (21.3, 27.5)	0.510
Distance to tumour from AV (cm), median (IQR)	4.0 (3.0, 7.0)	4.0 (3.0, 5.0)	0.358
Pathological type, n (%)			0.837
Adenocarcinoma	40 (97.6)	62 (96.9)
Non-adenocarcinoma	1 (2.4)	2 (3.1)
Preoperative radiotherapy, n (%)			0.356
Yes	10 (24.4)	21 (32.8)
No	31 (75.6)	43 (67.2)
Preoperative chemotherapy, n (%)			0.698
Yes	17 (41.5)	29 (45.3)
No	24 (58.5)	35 (54.7)
Surgical procedure, n (%)			0.371
Laparoscopic surgery	40 (97.6)	60 (93.8)
Conversion to open surgery	1 (2.4)	4 (6.2)
Surgical approach, n (%)			0.571
Dixon	23 (56.1)	31 (48.4)
Miles	18 (43.9)	32 (50.0)
Parks	0 (0)	1 (1.6)
LLND, n (%)			0.137
Unilateral dissection	33 (80.5)	43 (67.2)
Bilateral dissection	8 (19.5)	21 (32.8)
Pathological tumor stagea, n (%)			0.808
0-I	6 (14.6)	10 (15.6)
II	7 (17.1)	8 (12.5)
III	28 (68.3)	46 (71.9)
Adjuvant therapy, n (%)			0.544
Yes	32 (78.0)	53 (82.8)
No	9 (22.0)	11 (17.2)

^aThe eighth edition of the American Joint Committee on Cancer TNM staging system.

IQR: Interquartile range; BMI: Body mass index; AV: Anal verge; LLND: Lateral lymph node dissection.

Table 2 Surgical outcomes of the entire cohort (n = 105)

Variables	Fascia-oriented group (n = 41)	Vessel-oriented group (n = 64)	P value
Operation time (min), median (IQR)	245.0 (220.0, 270.0)	269.5 (210.0, 300.0)	0.908
Blood loss (mL), n (%)			0.242
≥ 300	1 (2.4)	6 (9.4)
< 300	40 (97.6)	58 (90.6)
No. of examined LLN, median (IQR)	9.0 (7.0, 13.0)	6.5 (3.0, 10.3)	0.020
Pathological LLN, n (%)			0.720
Positive	9 (22.0)	16 (25.0)
Negative	32 (78.0)	48 (75.0)
Surgical complicationsa, n (%)			0.852
Yes	4 (9.8)	5 (7.8)
No	37 (90.2)	59 (92.2)
Urinary dysfunction, n (%)			0.015
Yes	9 (22.0)	29 (45.3)
No	32 (78.0)	35 (54.7)
Male sexual dysfunction, n (%)			0.019
Yes	9 (42.9)	26 (74.3)
No	12 (57.1)	9 (25.7)
Lower limb dysfunction, n (%)			0.554
Yes	10 (24.4)	19 (29.7)
No	31 (75.6)	45 (70.3)
Post-operative hospital stay (d), median (IQR)	7.00 (7.00, 8.00)	8.00 (7.00, 9.00)	0.435
Perioperative mortality, n (%)	0 (0)	0 (0)	1.000
Reoperation, n (%)	0 (0)	0 (0)	1.000

^aSpecific surgical complications in the fascia-oriented group, n (%): Anastomotic bleeding, 1 (2.4); anastomotic leakage, 1 (2.4); lymphorrhagia, 1 (2.4); delayed wound healing, 1 (2.4). Specific surgical complications in the vessel-oriented group, n (%): Anastomotic leakage, 3 (4.7); ileus, 1 (1.6); abdominal infection, 1 (1.6).

IQR: Interquartile range; LLN: Lateral lymph nodes.

Table 3 Univariable and multivariable Cox regression analyses of overall survival of the entire cohort (n = 105)

	Univariable		Multivariable
	HR (95%CI)	P value	HR (95%CI)	P value
LLND method
Vessel–oriented LLND	Reference		Reference
Fascia–oriented LLND	0.95 (0.36–2.50)	0.918	0.94 (0.35–2.48)	0.893
Age
< 65	Reference		—
≥ 65	2.56 (0.87–7.51)	0.088	—
Sex
Male	Reference		—
Female	0.78 (0.30–2.06)	0.621	—
p/yp tumor stagea
0–II	Reference		Reference
III	9.98 (1.32–75.55)	0.026	9.66 (1.25–74.66)	0.030
Pathological LLN
Negative	Reference		Reference
Positive	1.82 (0.64–5.18)	0.264	1.14 (0.39–3.31)	0.807
Adjuvant therapy
No	Reference		—
Yes	—	0.202	—

^aThe pathological tumor stage was based on the eighth edition of the American Joint Committee on Cancer TNM staging system.

LLND: Lateral lymph node dissection; LLN: Lateral lymph nodes; HR: Hazard ratio.

Table 4 Univariable and multivariable Cox regression analyses of progression-free survival of the entire cohort (n = 105)

	Univariable		Multivariable
	HR (95%CI)	P value	HR (95%CI)	P value
LLND method
Vessel–oriented LLND	Reference		Reference
Fascia–oriented LLND	1.17 (0.51 - 2.68)	0.709	1.16 (0.51–2.66)	0.729
Age
< 65	Reference		—
≥ 65	1.20 (0.47 - 3.07)	0.706	—
Sex
Male	Reference		—
Female	0.7 (0.31-1.55)	0.374	—
p/yp tumor stagea
0–II	Reference		Reference
III	2.99 (1.02–8.76)	0.045	3.16 (1.04–9.60)	0.042
Pathological LLN
Negative	Reference		Reference
Positive	0.83 (0.33 - 2.12)	0.703	0.83 (0.31–2.22)	0.714
Adjuvant therapy
No	Reference		—
Yes	2.08 (0.62-7.02)	0.239	—

^aThe pathological tumor stage was based on the eighth edition of the American Joint Committee on Cancer TNM staging system.

LLND: Lateral lymph node dissection; LLN: Lateral lymph nodes; HR: Hazard ratio.