A Case with Residual Obturator Lymph Node Resected Laparoscopically after Lateral Lymph Node Dissection

The patient was a 64-year old female. At the age of 60, intersphincteric resection (ISR) and left lateral lymph node dissection were performed for low rectal cancer with left obturator lymph node enlargement. Lateral lymph node dissection (LLND) was performed using small laparotomy following laparoscopic rectal resection. No metastasis was identified in the harvested lateral lymph nodes. Although postoperative CT scans showed a left obturator lymph node suggesting incom-plete LLND, the size of the lymph node gradually increased. At 40 months after resection, the lymph node was further enlarged with high SUV uptake in FDG-PET examination. Therefore, the left obturator lymph node was dissected laparoscopically at 43 months after surgery, and metastasis was identified by pathological examination. The patient was discharged on the 6th postoperative day without complications. There was no recurrence 14 months after laparoscopic LLND. The clinical course of the patient suggests the superiority of the laparoscopic approach for LLND.

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