Annals of Coloproctology

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Colorectal cancer

The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes: Gyu-Seog Choi, Hye Jin Kim; Ann Coloproctol. 2024;40(4):363-374. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00521.0074

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Metastatic lateral pelvic lymph nodes (LPNs) in rectal cancer significantly impact the prognosis and treatment strategies. Western practices emphasize neoadjuvant chemoradiotherapy (CRT), whereas Eastern approaches often rely on LPN dissection (LPND). This review examines the evolving role of LPND in the context of modern treatments, including total neoadjuvant therapy (TNT), and the impact of CRT on the management of clinically suspicious LPNs. We comprehensively reviewed the key literature comparing the outcomes of LPND versus preoperative CRT for rectal cancer, focusing on recent advancements and ongoing debates. Key studies, including the JCOG0212 trial and recent multicenter trials, were analyzed to assess the efficacy of LPND, particularly in conjunction with preoperative CRT or TNT. Current evidence indicates that LPND can reduce local recurrence rates compared to total mesorectal excision alone in patients not receiving radiation therapy. However, the benefit of LPND in the context of neoadjuvant CRT is influenced by the size and pretreatment characteristics of LPNs. While CRT can effectively control smaller metastatic LPNs, larger or clinically suspicious LPNs may require LPND for optimal outcomes. Advances in surgical techniques, such as robotic-assisted LPND, offer potential benefits but also present challenges and complications. The role of TNT in controlling metastatic LPNs and improving patient outcomes is emerging but remains underexplored. The decision to perform LPND should be individualized based on patient-specific factors, including LPN size, response to neoadjuvant treatment, and surgeon expertise. Future research should focus on optimizing treatment protocols and further evaluating the role of TNT in managing metastatic LPNs.

Citations

Citations to this article as recorded by

Locally Recurrent Rectal Cancer in the Lateral Compartment: Imaging Features and Association with Primary Tumour Characteristics
F. E. C. Vande Kerckhove, D. M. J. Creemers, E. Banken, S. H. J. Ketelaers, R. R. J. Coebergh van den Braak, G. A. P. Nieuwenhuijzen, A. E. Verrijssen, A. W. Daniëls-Gooszen, T. R. van Oudheusden, S. G. van Ravensteijn, I. E. G. van Hellemond, H. J. T. Ru
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Cancer-associated fibroblasts enhance colorectal cancer lymphatic metastasis via CLEC11A/LGR5-mediated WNT pathway activation
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Colorectal Disease.2025;[Epub] CrossRef
Learning curve for lateral lymph node dissection in rectal cancer – a systematic review of literature
D. Kehagias, L. Baldari, E. Cassinotti, L. Boni, C. Lampropoulos, I. Kehagias
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Pelvic Neuroanatomy in Colorectal Surgery: Advances in Nerve Preservation for Optimized Functional Outcomes
Asim M. Almughamsi, Yasir Hassan Elhassan
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Gyung Mo Son
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Video

Tips and tricks for robotic lateral pelvic node dissection: James Chi-Yong Ngu, Nan-Zun Teo; Ann Coloproctol. 2023;39(6):531-531. Published online December 26, 2023; DOI: https://doi.org/10.3393/ac.2023.00766.0109

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157 Download

Abstract PDF Supplementary Material: Lateral pelvic node dissection can be challenging. In addition to detailed anatomical knowledge of the pelvic side wall, surgeons also need to be proficient in performing fine dissection within the confines of this limited operative field. While the incorporation of robotics can facilitate the safe completion of this technically demanding procedure, this is nonetheless dependent on the way the robotic system is used. This video aims to demonstrate several tips and tricks for performing robotic lateral pelvic node dissection.

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