Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery
Abstract Background Lateral lymph node dissection (LLND) for locally advanced rectal cancer (LARC) is performed widely since it reduces local recurrence. However, there are some disadvantages to LLND, including technical difficulties and association with postoperative urinary dysfunction. Procedures...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-12-01
|
| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-024-02697-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850103419391442944 |
|---|---|
| author | Makoto Takahashi Kazuhiro Sakamoto Hisashi Ro Saki Kochi Miyuki Toake Hiromitsu Takahashi Takahiro Irie Hirotaka Momose Kota Amemiya Yuki Tsuchiya Ryoichi Tsukamoto Kumpei Honjo Masaya Kawai Shun Ishiyama Kiichi Sugimoto Yutaka Kojima |
| author_facet | Makoto Takahashi Kazuhiro Sakamoto Hisashi Ro Saki Kochi Miyuki Toake Hiromitsu Takahashi Takahiro Irie Hirotaka Momose Kota Amemiya Yuki Tsuchiya Ryoichi Tsukamoto Kumpei Honjo Masaya Kawai Shun Ishiyama Kiichi Sugimoto Yutaka Kojima |
| author_sort | Makoto Takahashi |
| collection | DOAJ |
| description | Abstract Background Lateral lymph node dissection (LLND) for locally advanced rectal cancer (LARC) is performed widely since it reduces local recurrence. However, there are some disadvantages to LLND, including technical difficulties and association with postoperative urinary dysfunction. Procedures for LARC have also become more minimally invasive: laparoscopic surgery (LS) has become more common, and use of robot-assisted LS (RALS) is increasing. The purpose of this study is to assess differences in postoperative urinary dysfunction after LLND for LARC between LS and RALS, and to identify risk factors for postoperative urinary dysfunction. Methods The subjects were 100 patients with LARC (≥ cT3) with the inferior border of the tumor reaching the peritoneal reflection who underwent LS or RALS with LLND between 2009 and 2023 at Juntendo University Hospital. After LLND, the urinary catheter was usually removed on or before postoperative day 5. The duration of urinary catheterization (DUC) was used to evaluate postoperative urinary dysfunction. The standard (S) and long-term (L) groups were defined as cases with urinary catheter removal at ≤ 5 and > 5 days, respectively. DUC was examined for LS vs. RALS and clinicopathological factors were identified that adversely affect DUC. Results Of the 100 subjects, 72 underwent LS and 28 received RALS. LLND was bilateral in 65 cases and unilateral in 35 cases. The median DUC was 5 days, with 74 cases in group S and 26 in group L. The most frequent postoperative complication (Clavien-Dindo Grade 2 or higher) was urinary dysfunction, followed by ileus and surgical site infection (SSI), and none differed by procedure (LS vs. RALS). Univariate analysis showed significant differences in LLND laterality (p = 0.02) and SSI (p = 0.04) between groups S and L. In multivariate analysis, bilateral LLND (p < 0.01, HR 7.37) and SSI (p = 0.01, HR 15.36) were independent factors that worsened DUC. Conclusions There was no difference in urinary dysfunction after LLND between LS and RALS. Bilateral LLND and SSI were risk factors for lengthening DUC. Compared to bilateral LLND, unilateral LLND can reduce urinary dysfunction; therefore, selective LLND, which is overwhelmingly unilateral LLND, and prevention of perioperative SSI may be important for maintenance of urinary function. |
| format | Article |
| id | doaj-art-4918e71f92ba47ceb145908e3335149c |
| institution | DOAJ |
| issn | 1471-2482 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj-art-4918e71f92ba47ceb145908e3335149c2025-08-20T02:39:34ZengBMCBMC Surgery1471-24822024-12-0124111110.1186/s12893-024-02697-5Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgeryMakoto Takahashi0Kazuhiro Sakamoto1Hisashi Ro2Saki Kochi3Miyuki Toake4Hiromitsu Takahashi5Takahiro Irie6Hirotaka Momose7Kota Amemiya8Yuki Tsuchiya9Ryoichi Tsukamoto10Kumpei Honjo11Masaya Kawai12Shun Ishiyama13Kiichi Sugimoto14Yutaka Kojima15Department of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineAbstract Background Lateral lymph node dissection (LLND) for locally advanced rectal cancer (LARC) is performed widely since it reduces local recurrence. However, there are some disadvantages to LLND, including technical difficulties and association with postoperative urinary dysfunction. Procedures for LARC have also become more minimally invasive: laparoscopic surgery (LS) has become more common, and use of robot-assisted LS (RALS) is increasing. The purpose of this study is to assess differences in postoperative urinary dysfunction after LLND for LARC between LS and RALS, and to identify risk factors for postoperative urinary dysfunction. Methods The subjects were 100 patients with LARC (≥ cT3) with the inferior border of the tumor reaching the peritoneal reflection who underwent LS or RALS with LLND between 2009 and 2023 at Juntendo University Hospital. After LLND, the urinary catheter was usually removed on or before postoperative day 5. The duration of urinary catheterization (DUC) was used to evaluate postoperative urinary dysfunction. The standard (S) and long-term (L) groups were defined as cases with urinary catheter removal at ≤ 5 and > 5 days, respectively. DUC was examined for LS vs. RALS and clinicopathological factors were identified that adversely affect DUC. Results Of the 100 subjects, 72 underwent LS and 28 received RALS. LLND was bilateral in 65 cases and unilateral in 35 cases. The median DUC was 5 days, with 74 cases in group S and 26 in group L. The most frequent postoperative complication (Clavien-Dindo Grade 2 or higher) was urinary dysfunction, followed by ileus and surgical site infection (SSI), and none differed by procedure (LS vs. RALS). Univariate analysis showed significant differences in LLND laterality (p = 0.02) and SSI (p = 0.04) between groups S and L. In multivariate analysis, bilateral LLND (p < 0.01, HR 7.37) and SSI (p = 0.01, HR 15.36) were independent factors that worsened DUC. Conclusions There was no difference in urinary dysfunction after LLND between LS and RALS. Bilateral LLND and SSI were risk factors for lengthening DUC. Compared to bilateral LLND, unilateral LLND can reduce urinary dysfunction; therefore, selective LLND, which is overwhelmingly unilateral LLND, and prevention of perioperative SSI may be important for maintenance of urinary function.https://doi.org/10.1186/s12893-024-02697-5Lateral lymph node resectionUrinary dysfunctionRemoval of urinary catheterDuration of urinary catheterizationRobot-assisted laparoscopic surgeryLaparoscopic surgery |
| spellingShingle | Makoto Takahashi Kazuhiro Sakamoto Hisashi Ro Saki Kochi Miyuki Toake Hiromitsu Takahashi Takahiro Irie Hirotaka Momose Kota Amemiya Yuki Tsuchiya Ryoichi Tsukamoto Kumpei Honjo Masaya Kawai Shun Ishiyama Kiichi Sugimoto Yutaka Kojima Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery BMC Surgery Lateral lymph node resection Urinary dysfunction Removal of urinary catheter Duration of urinary catheterization Robot-assisted laparoscopic surgery Laparoscopic surgery |
| title | Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| title_full | Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| title_fullStr | Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| title_full_unstemmed | Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| title_short | Postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| title_sort | postoperative urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery |
| topic | Lateral lymph node resection Urinary dysfunction Removal of urinary catheter Duration of urinary catheterization Robot-assisted laparoscopic surgery Laparoscopic surgery |
| url | https://doi.org/10.1186/s12893-024-02697-5 |
| work_keys_str_mv | AT makototakahashi postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT kazuhirosakamoto postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT hisashiro postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT sakikochi postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT miyukitoake postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT hiromitsutakahashi postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT takahiroirie postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT hirotakamomose postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT kotaamemiya postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT yukitsuchiya postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT ryoichitsukamoto postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT kumpeihonjo postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT masayakawai postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT shunishiyama postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT kiichisugimoto postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery AT yutakakojima postoperativeurinarydysfunctionfollowinglaterallymphnodedissectionforrectalcancerviaminimallyinvasivesurgery |