Bilateral laparosocopic lateral lymph node dissection by the totally extraperitoneal approach after intersphincteric resection of the lower rectum: report of a case

INTRODUCTION AND IMPORTANCE: Lateral lymph node dissection (LLND) for recurrent lateral pelvic lymph node metastasis could be the only surgical treatment to improve its prognosis, but is difficult and challenging technically. CASE PRESENTATION: A 75-year-old Japanese man who underwent a radical laparoscopic intersphincteric resection to treat double lower rectal cancer. Computed tomography and MRI showed lower rectal wall thickening and bilateral lateral lymph node swelling. The authors scheduled and performed the LLND for recurrent lateral pelvic lymph nodes after ISR by the totally extraperitoneal (TEP) approach. The bottom of the obturators lymph node (#263D) were positive for metastasis histologically. CLINICAL DISCUSSION: The TEP approach is an especially effective option for the treatment of bilateral LLND. CONCLUSION: Herein, the authors introduce our surgical technique: successful challenging treatment of the LLND by the TEP approach after intersphincteric resection of the lower rectum.