Lateral lymph node dissection in rectal cancer: State of the art review

Hazen, Sanne-Marije J. A.; Sluckin, Tania C.; Konishi, Tsuyoshi; Kusters, Miranda

doi:10.1016/j.ejso.2021.11.003

Cited by 17 publications

(12 citation statements)

References 53 publications

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“…What the size and anatomical location is of an LLN and whether it is considered malignant are vital pieces of information that should be accurately investigated, mentioned in radiology reports and discussed during MDT meetings [20,21]. This study investigated if inter-physician variation was present for the measurement of LLN short-axis size, anatomical location, and for the judgement of whether an LLN is suspicious.…”

Section: Introductionmentioning

confidence: 99%

Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

et al. 2022

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Objectives In patients with rectal cancer, the size and location of lateral lymph nodes (LLNs) are correlated to increased lateral local recurrence rates. Sufficient knowledge and accuracy when measuring these features are therefore essential. The objective of this study was to evaluate the variation in measurements and anatomical classifications of LLNs before and after training. Methods Fifty-three Dutch radiologists examined three rectal MRI scans and completed a questionnaire. Presence, location, size, and suspiciousness of LLNs were reported. This assessment was repeated after a 2-hour online training by the same radiologists with the same three cases plus three additional cases. Three expert radiologists independently evaluated these 6 cases and served as the standard of reference. Results Correct identification of the anatomical location improved in case 1 (62 to 77% (p = .077)) and in case 2 (46 to 72% (p = .007)) but decreased in case 3 (92 to 74%, p = .453). Compared to the first three cases, cases 4, 5, and 6 all had a higher initial consensus of 73%, 79%, and 85%, respectively. The mean absolute deviation of the short-axis measurements in cases 1–3 were closer—though not significantly—to the expert reference value after training with reduced ranges and standard deviations. Subjective determination of malignancy had a high consensus rate between participants and experts. Conclusion Though finding a high consensus rate for determining malignancy of LLNs, variation in short-axis measurements and anatomical location classifications were present and improved after training. Adequate training would support the challenges involved in evaluating LLNs appropriately. Key Points • Variation was present in the assessment of the anatomical location and short-axis size of lateral lymph nodes. • In certain cases, the accuracy of short-axis measurements and anatomical location, when compared to an expert reference value, improved after a training session. • Consensus before and after training on whether an LLN was subjectively considered to be suspicious for malignancy was high.

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Section: Introductionmentioning

confidence: 99%

Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

et al. 2022

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“…Hazen et al reviewed the treatment of lateral lymph nodes in rectal cancer and state that they will change towards selective LLND in the future. [ 21 ] Therefore, it is important to develop predictors of lateral lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer and control of lateral lymph node metastasis

et al. 2022

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Introduction Standard treatment strategy for low rectal cancer in Japan is different from Western countries. Total mesorectum excision (TME) + lateral lymph node dissection (LLND) is mainly carried out in Japan, whereas neoadjuvant chemoradiotherapy (nCRT) + TME is selected in Western countries. There is no clear definition of preoperative diagnosis of lateral lymph node metastasis. If we can predict lateral lymph node swelling that can be managed by nCRT from lateral lymph node swelling that require surgical resection, clinical benefit is significant. In the current study we assessed characteristics of the lateral lymph node recurrence (LLNR) and LLND that can be managed by nCRT. Patients and Methods Patients with low rectal cancer (n = 168) underwent nCRT between 2009 and 2016. We evaluated CEA, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lateral lymph node short axis pre and post nCRT, respectively, and also evaluated tumor shrinkage rate, tumor regression grade (TRG). We evaluated the relationship between each and LLNR. Results LLND was not carried out all patients. Factors associated with LLNR were PLR and lymph node short axis pre and post nCRT. (p = 0.0269, 0.0278, p < 0.0001, p < 0.0001, respectively). Positive recurrence cut-off values of lateral lymph node short-axis calculated were 11.6 mm pre nCRT and 5.5 mm post nCRT. Conclusion Results suggest that PLR before and after CRT was associated with control of LLNR, and LLND should be performed on lateral lymph nodes with short-axis of 5 mm and 11 mm pre and post nCRT.

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“…The dissection begins with the identification of the ureter at the site where it crosses the iliac vessels and is mobilized medially. The ureterohypogastric fascia separating the fat around the ureter and hypogastric nerves from the fat of the lateral compartment is then developed, establishing the medial boundary of dissection 23 . The psoas and internal obturator muscles comprise the lateral dissection plane; this is established by exposing the external iliac vein behind the iliac artery and removing the lymphoareolar tissue of the obturator node group along the medial border of the vein 21 .…”

Section: Surgical Techniquementioning

confidence: 99%

“…The ureterohypogastric fascia separating the fat around the ureter and hypogastric nerves from the fat of the lateral compartment is then developed, establishing the medial boundary of dissection. 23 The psoas and internal obturator muscles comprise the lateral dissection plane; this is established by exposing the external iliac vein behind the iliac artery and removing the lymphoareolar tissue of the obturator node group along the medial border of the vein. 21 The obturator vessels and nerve are identified, and the vessels are ligated while the nerve is preserved.…”

Section: Surgical Techniquementioning

confidence: 99%

Management of lateral pelvic lymph nodes in rectal cancer

Chang

Halabi²,

Ali

2023

Journal of Surgical Oncology

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Lateral pelvic lymph node (LPLN) involvement occurs in 10%–25% of rectal cancer cases. Total mesorectal excision (TME) with routine LPLN dissection (LPLND) is predominantly applied in Japan whereas TME with neoadjuvant treatment are used in the West. LPLND is a morbid procedure and minimally invasive techniques may help reduce its morbidity. Selective lateral pelvic node dissection with TME following neoadjuvant treatment achieves acceptable disease‐free and overall survival.

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Lateral lymph node dissection in rectal cancer: State of the art review

Cited by 17 publications

References 53 publications

Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer

Predictors and histological effects of preoperative chemoradiotherapy for rectal cancer and control of lateral lymph node metastasis

Management of lateral pelvic lymph nodes in rectal cancer

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