Lateral Lymph Node Metastasis Is a Major Cause of Locoregional Recurrence in Rectal Cancer Treated With Preoperative Chemoradiotherapy and Curative Resection

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

“…The incidence of lateral pelvic lymph node metastasis in locally advanced mid-and low-rectal cancer ranges from 10% to 25% [47,48] . In Japan, lateral pelvic lymph node involvement is considered as loco-regional disease, and in West, it is regarded as systemic disease [49][50][51] .…”

“…In Japan, lateral pelvic lymph node involvement is considered as loco-regional disease, and in West, it is regarded as systemic disease [49][50][51] . Thus, present strategies for the management of lateral pelvic lymph node are TME with neo-adjuvant chemo-radiotherapy and/or lateral pelvic lymph node dissection [47,[52][53][54] . The recent study suggested that patients with lateral pelvic lymph nodes responsive to neoadjuvant chemo-radiotherapy may not benefit from lateral pelvic lymph node dissection and subgroup with persistent lateral pelvic lymph node following neo-adjuvant chemo-radiotherapy may benefit from lateral pelvic lymph node dissection [8] .…”

IGRT in rectal cancer

“…Particularly the recurrences are mostly described in the lower two-thirds of the pelvis while lateral recurrence does not seem to be a major cause of local failure after TME [17]. Nevertheless the role of lateral pelvic lymph node dissection remains controversial especially in patients with clinical suspected lateral node disease [19]. Moreover, preoperative radiotherapy can be effective in the reduction of local failure in the lateral pelvis [20].…”

Selection of surgical approach and role of lymph node dissection at colorectal cancer

“…Однако, учитывая частоту метастазирования в латеральные тазовые ЛУ, а по японским данным она выше, чем частота метастазирования в ЛУ по ходу верхней ректальной и нижней брыжеечной артерии, безусловно, проведение тазовой диссекции имеет лучшие перспективы для больных, чем высокая пе-ревязка нижней брыжеечной артерии [24]. Более того, метастазы в латеральные ЛУ обусловливали бо льшую часть рецидивов (82,7 %) после комплексного лече-ния [25]. Однако доказательной базы о преимущест-вах аортоподвздошно-тазовой лимфодиссекции нет.…”