摘要
Abstract
Objective To investigate the clinical efficacy of the fascia-guided anatomical approach for lymph node dissection during laparoscopic anterior resection for advanced rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 90 patients with advanced rectal cancer admitted between August 2020 and August 2023.All patients underwent standard laparoscopic anterior resection with total mesorectal excision.Based on the surgical approach,patients were divided into a control group and an observation group(45 patients each).The control group underwent lymph node dissection via a vessel-oriented anatomical approach centered on the inferior mesenteric artery,while the observation group underwent the procedure via a fascia-guided anatomical approach using the Toldt fascia as a landmark.Surgery-related indicators,clinical efficacy,and the incidence of short-term complications were compared between the two groups.All patients were followed up for 12 months,and survival analysis was performed using the Kaplan-Meier method.Results Compared with the control group,the observation group showed a significantly higher number of dissected lymph nodes and a higher overall effective rate(P<0.05),while the incidence of complications was significantly lower(P<0.05).During the 1-year follow-up,there were 4 deaths and 9 cases of disease progression in the observation group,compared to 6 deaths and 15 cases of disease progression in the control group.Kaplan-Meier survival analysis revealed no statistically significant differences in the 1-year overall survival and progression-free survival rates between the two groups(Log-rank χ2=0.546,P=0.460,Log-rank χ2=2.258,P=0.133).Conclusion In laparoscopic anterior resection of the rectum,the fascia-guided anatomical approach for lymph node dissection yields a higher number of dissected lymph nodes,superior short-term efficacy,and a lower complication rate compared with the vascular-oriented approach based on appropriate indication selection,with comparable short-term survival outcomes between the two approaches.关键词
直肠肿瘤/筋膜导向解剖入路/腹腔镜手术/直肠前切除术Key words
rectal neoplasms/fascia-guided anatomical approach/laparoscopy/anterior resection of rectum
