進行直腸癌に対する腹腔鏡下側方リンパ節郭清の短・長期成績

Short-and long-term outcomes of laparoscopic lateral lymph node dissection for advanced rectal cancer

◆要旨：【目的】腹腔鏡下側方リンパ節郭清（以下，LLND）の適応の妥当性と技術的および腫瘍学的な安全性を評価した．【方法・対象】2012年9月から2018年12月までに当院でLLNDを施行した75例．腹腔鏡下群（以下，L群）38例の短・長期成績を，開腹群（以下，O群）37例および既報と後方視的に比較検討した．【結果】L群ではO群と比較してpStageⅡ以下の症例が多い傾向があった．Clavien-Dindo分類GradeⅡ以上の合併症発生率に差はなかったが，L群で神経因性膀胱が多かった（31.6％）．局所再発率はL群で低い傾向にあった（5.3％vs．16.2％，p＝0.124）．L群の局所再発は2例とも右側Alcock管遠位の肛門挙筋に接する部位だった．cStageⅡ，Ⅲの5年無再発生存割合は85.3％で，JCOG0212試験や他の既報の成績に劣らなかった．【考察】当院における腹腔鏡下LLNDは腫瘍学的に安全に実施できていると考えられる．技術的には神経因性膀胱の減少が課題である．

　［Purpose］We evaluated the technical and oncological safety of laparoscopic lateral lymph node dissection（LLND）in our hospital.［Methods］The subjects were retrospectively compared with the short and long-term outcomes of 75 patients who underwent LLND in our hospital from September 2012 to December 2018. There were 38 cases of laparoscopic LLND（L group）and 37 cases of open LLND（O group）. The short and long-term outcomes were analyzed retrospectively.［Results］The proportion of pStage 0, I, II was larger in L group. There was no difference in the incidence of complications above Clavien-Dindo classification Grade II. The incidence of neurogenic bladder was 31.6％in L group and 16.2％in O group. Two cases of the local recurrence in L group developed at the distal area of the Alcock's canal. The 5-year disease-free survival（DFS）of cStage II and III was 85％in the L group. This outcome would not be inferior to DFS in studies previously reported including the JCOG0212 trial.［Conclusion］Although it is a retrograde single center study, laparoscopic LLND in our hospital could be performed safely in carefully selected patients. Reducing the incidence of the neurogenic bladder is our challenge.