Analysis of influencing factors of neurological function status after lateral lymph node dissection for rectal cancer

[Objectives] To investigate the status of neurological function and its influencing factors after lateral lymph node dissection (LLND) in patients with rectal cancer. [Methods] Clinical data were retrospectively collected from 196 rectal cancer patients who underwent LLND at the National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences between July 2014 and August 2021. According to the exclusion criteria, 91 patients were excluded, and 105 patients were included in the final analysis. Patients were categorized into a neurological dysfunction group (n＝78) and a normal neurological function group (n＝27) based on their neurological status post-LLND. Clinicopathological data were compared between the two groups, and univariate and multivariate logistic regression analyses were conducted to identify influencing factors of postoperative neurological function. [Results] Among the 105 patients, 27 (25.7%) had normal neurological function, while 78 (74.3%) experienced neurological dysfunction. Specifically, 38 patients had urinary dysfunction, 62 had sexual dysfunction, and 29 had lower limbs sensory and motor dysfunction. There were no significant differences in gender, age, preoperative neoadjuvant chemoradiotherapy, tumor T stage, presence of lymph node metastasis, and surgical approach between the two groups (P>0.05). A higher proportion of patients in the normal neurological function group underwent fascia-oriented LLND and unilateral LLND compared to the neurological dysfunction group (P<0.05). Univariate and multivariate logistic regression analyses revealed that fascia-oriented LLND was a protective factor for postoperative neurological function (OR＝0.275, 95%CI: 0.106-0.720, P＝0.019). [Conclusion] The incidence of postoperative neurological dysfunction is high in rectal cancer patients who undergo LLND. Fascia-oriented LLND is a protective factor for postoperative neurological function.