Annals of Coloproctology

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Original Article

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy,Colorectal cancer

Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review: Min Chul Kim, Jae Hwan Oh; Ann Coloproctol. 2021;37(6):382-394. Published online December 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00913.0130

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22 Web of Science
22 Citations

Purpose
We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).
Methods
We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.
Results
The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).
Conclusion
This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Citations

Citations to this article as recorded by

MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy
Min Jeong Cho, Kyunghwa Han, Hye Jung Shin, Woong Sub Koom, Kang Young Lee, Joo Hee Kim, Joon Seok Lim
European Radiology.2025; 35(8): 4967. CrossRef
Feasibility and limitations of combined treatment for lateral pelvic lymph node metastases in rectal cancer
Ying-Zi Zheng, Fang-Fang Yan, Lian-Xiang Luo
World Journal of Clinical Oncology.2024; 15(5): 591. CrossRef
Totally Extraperitoneal Approach for Recurrent Lateral Pelvic Lymph Nodes After Rectal Cancer Surgery
Tae-Gyun Lee, Hong-Min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang
Diseases of the Colon & Rectum.2024; 67(6): e360. CrossRef
Identification of lateral pelvic nodes without metastasis in patients with rectal cancer treated with preoperative chemoradiotherapy or chemotherapy based on magnetic resonance imaging
Nobuaki Hoshino, Yudai Fukui, Kohei Ueno, Koya Hida, Kazutaka Obama, Kazuhiro Sakamoto, Hirotoshi Kobayashi, Michio Itabashi, Soichiro Ishihara, Kazushige Kawai, Yoichi Ajioka
Annals of Gastroenterological Surgery.2024; 8(5): 732. CrossRef
Survival analysis in rectal cancer patients after lateral lymph node dissection: Exploring the necessity of nCRT for suspected lateral lymph node metastasis
Jiafei Liu, Peishi Jiang, Zhichun Zhang, Hongjie Yang, Yuanda Zhou, Peng Li, Qingsheng Zeng, Xipeng Zhang, Yi Sun
Current Problems in Surgery.2024; 61(8): 101525. CrossRef
Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement
Jeong Ha Lee, Nalee Kim, Jeong Il Yu, Gyu Sang Yoo, Hee Chul Park, Woo-Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin, Joon Oh Park, Seung Tae Kim, Young Suk Park, Jeeyun Lee, Won Ki Kang
Radiation Oncology Journal.2024; 42(2): 130. CrossRef
Literature research on the low rectal cancer complicated with lateral pelvic lymph node metastasis
Miao He, Jing Fan
Asian Journal of Surgery.2024; 47(10): 4575. CrossRef
Innovációk a colorectalis sebészetben
Balázs Bánky, András Fülöp, Viktória Bencze, Lóránd Lakatos, Petra Rozman, Attila Szijártó
Orvosi Hetilap.2024; 165(2): 43. CrossRef
Meta-analysis of the efficacy and safety of robot-assisted comparative laparoscopic surgery in lateral lymph node dissection for rectal cancer
Hao Shi, Xianhao Yi, Xin Yan, Wenjie Wu, Hui Ouyang, Chengke Ou, Xiangheng Chen
Surgical Endoscopy.2024; 38(10): 5584. CrossRef
The Role of Lateral Pelvic Lymph Node Dissection in Middle and Lower Rectal Cancer (Stage II or III): A Literature Review
Alexandra-Eleftheria Menni, Georgios Tzikos, Patroklos Goulas, Stylianos Apostolidis
Cureus.2024;[Epub] CrossRef
Lateral pelvic lymph node positivity (LPLNP) score: predictive clinic-radiological model of lateral pelvic lymph node involvement in rectal cancer patients
Petr Tsarkov, Vladimir Balaban, Harutyun Babajanyan, Abe Fingerhut, Inna Tulina, Mingze He
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Short-term outcomes of 47 selective laparoscopic lymph node dissection for rectal cancer: A retrospective study
Xiajuan Xue, Shuijie Lin, Qunzhang Zeng, Yincong Guo
Medicine.2024; 103(43): e39684. CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
Development of a Diagnostic Artificial Intelligence Tool for Lateral Lymph Node Metastasis in Advanced Rectal Cancer
Kosuke Ozaki, Yusuke Kurose, Kazushige Kawai, Hirotoshi Kobayashi, Michio Itabashi, Yojiro Hashiguchi, Takuya Miura, Akio Shiomi, Tatsuya Harada, Yoichi Ajioka
Diseases of the Colon & Rectum.2023; 66(12): e1246. CrossRef
Advances in the Treatment of Colorectal Cancer with Peritoneal Metastases: A Focus on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Youngbae Jeon, Eun Jung Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
In Ja Park
The Ewha Medical Journal.2022; 45(1): 3. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef
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Sung Uk Bae
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It Is a Pleasure to Announce the Issue Titled “Master Class 2021” in Annals of Coloproctology
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Annals of Coloproctology.2021; 37(6): 349. CrossRef

Video

Malignant disease, Rectal cancer,Minimally invasive surgery,Surgical technique

Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection: Jung Hoon Bae, Wooree Koh, Hyun Ho Kim, Yoon Suk Lee; Ann Coloproctol. 2021;37(1):58-60. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.05

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277 Download
12 Web of Science
13 Citations

Abstract PDF Supplementary Material

We aimed to show that a standardized step-by-step robotic approach using surgical landmarks could make lateral pelvic lymph node dissection (LPND) less complicated. We performed robot-assisted LPND consisting of 4 steps using surgical landmarks. The first step is a dissection of uretero-hypogastric fascia, which envelopes the ureter and the hypogastric nerve. The second step is a dissection of the medial side of the external iliac vein located at the lateral border of the obturator lymph nodes (LNs) group. The third step is a dissection of the vesico-hypogastric fascia, which is at the medial border of the obturator LNs group. The final step is a dissection of the internal iliac artery until the Alcock’s canal. Indocyanine green was injected just before surgery around the dentate line to identify the lateral pelvic LNs. Standardization using a robotic approach for LPND guided by surgical landmarks allows a safer and more effective surgery.

Citations

Citations to this article as recorded by

The first video comparison of lateral pelvic lymph node dissection in rectal cancer: Laparoscopic approach using articulating instruments (ArtiSential) versus robotic Xi platform—A video vignette
In Kyeong Kim, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee
Colorectal Disease.2025;[Epub] CrossRef
MRI-based scoring systems for selective lateral lymph node dissection in locally advanced low rectal cancer after neoadjuvant chemoradiotherapy
Min Jeong Cho, Kyunghwa Han, Hye Jung Shin, Woong Sub Koom, Kang Young Lee, Joo Hee Kim, Joon Seok Lim
European Radiology.2025; 35(8): 4967. CrossRef
Short- and long-term outcomes of robot-assisted versus laparoscopic lateral lymph node dissection for rectal cancer
Daichi Kitaguchi, Tsuyoshi Enomoto, Kinji Furuya, Shuntaro Tsukamoto, Tatsuya Oda
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Is lateral pelvic lymph node dissection necessary for good responder to neoadjuvant chemoradiation in locally advanced rectal cancer?
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Surgical Oncology.2025; 61: 102249. CrossRef
Was there any change in surgical treatment for colorectal cancer during the COVID-19 pandemic?
Yeajin Moon, Seung Hun Lee, Seung Hyun Lee
Kosin Medical Journal.2025; 40(3): 207. CrossRef
The use of indocyanine green for lateral lymph node dissection in rectal cancer—preliminary data from an emerging procedure: a systematic review of the literature
D. Kehagias, C. Lampropoulos, A. Bellou, I. Kehagias
Techniques in Coloproctology.2024;[Epub] CrossRef
Japanese expert consensus on the standardization of robot‐assisted pelvic lymph node dissection in urological surgery: Extent of pelvic lymph node and surgical technique
Shuichi Morizane, Jun Miki, Masaki Shimbo, Toru Kanno, Noriyoshi Miura, Yuta Yamada, Takeshi Yamasaki, Takashi Saika, Atsushi Takenaka
International Journal of Urology.2024; 31(12): 1300. CrossRef
Simplified approach to the medial internal iliac region using a uretero‐hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot‐assisted radical prostatectomy for high‐risk prostate cancer
Masaki Shimbo, Takehiro Ohyama, Fumiyasu Endo, Kenji Komatsu, Yoko Kyono, Masayuki Sano, Kazutaka Narimoto, Kazunori Hattori
International Journal of Urology.2023; 30(2): 190. CrossRef
Lateral Lymph Node Size and Tumor Distance From Anal Verge Accurately Predict Positive Lateral Pelvic Lymph Nodes in Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Diseases of the Colon & Rectum.2023; 66(6): 785. CrossRef
Robotic Lateral Pelvic Lymph Node Dissection Could Harvest More Lateral Pelvic Lymph Nodes over Laparoscopic Approach for Mid-to-Low Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ri Na Yoo, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Biomedicines.2023; 11(6): 1556. CrossRef
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef

Original Articles

Initial Clinical Experience with Robotic Lateral Pelvic Lymph Node Dissection for Advanced Rectal Cancer: Ju-A Park, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park; J Korean Soc Coloproctol. 2012;28(5):265-270. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.265

6,253 View
65 Download
37 Citations

Abstract PDF

Purpose

This study was conducted to evaluate the technical feasibility and safety of robotic extended lateral pelvic lymph node dissection (LPLD) in patients with advanced low rectal cancer.

Methods

A review of a prospectively-collected database at Kyungpook National University Medical Center from January 2011 to November revealed a series of 8 consecutive robotic LPLD cases with a preoperative diagnosis of lateral node metastasis. Data regarding patient demographics, operating time, perioperative blood loss, surgical morbidity, lateral lymph node status, and functional outcome were analyzed.

Results

In all eight patients, the procedures were completed without conversion to open surgery. The mean operative time of extended pelvic node dissection was 38 minutes (range, 20 to 51 minutes), the mean number of lateral lymph nodes harvested was 4.1 (range, 1 to 13), and 3 patients (38%) were found to have lymph node metastases. Postoperative mortality and morbidity were 0% and 25%, respectively, but, there was no LPLD-related morbidity. The mean hospital stay was 7.5 days (range, 5 to 12 days).

Conclusion

Robotic LPLD is safe and feasible, with the advantage of being a minimally invasive approach. Further large-scale studies comparing robotic and conventional surgery with long-term follow-up evaluation are needed to confirm these findings.

Citations

Citations to this article as recorded by

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T. Sueda, M. Yasui, J. Nishimura, Y. Kagawa, M. Kitakaze, R. Mori, C. Matsuda, Y. Ushimaru, T. Sugase, Y. Mukai, H. Komatsu, Y. Yanagimoto, T. Kanemura, K. Yamamoto, H. Wada, K. Goto, H. Miyata, M. Ohue
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Colorectal Disease.2025;[Epub] CrossRef
Short-term Outcomes of Robotic Lateral Pelvic Lymph Node Dissection for Lower Rectal Cancer
Wataru Sakamoto, Satoshi Fukai, Takahiro Sato, Misato Ito, Takuro Matsumoto, Mai Ashizawa, Shun Chida, Hisashi Onozawa, Hirokazu Okayama, Hisahito Endo, Motonobu Saito, Zenichiro Saze, Tomoyuki Momma, Koji Kono
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Short- and long-term outcomes of robot-assisted versus laparoscopic lateral lymph node dissection for rectal cancer
Daichi Kitaguchi, Tsuyoshi Enomoto, Kinji Furuya, Shuntaro Tsukamoto, Tatsuya Oda
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Research progress in lateral lymph node dissection for rectal cancer
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Short-term outcomes of 47 selective laparoscopic lymph node dissection for rectal cancer: A retrospective study
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Robot-assisted lateral pelvic lymph node dissection in patients with advanced rectal cancer: a single-center experience of 65 cases
Eon Bin Kim, Yong Sik Yoon, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
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Standardized Step-by-step Technique Using Surgical Landmarks in Robotic Lateral Pelvic Lymph Node Dissection
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Se-Jin Baek, Guglielmo Niccolò Piozzi, Seon-Hahn Kim
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Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
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Effect on the Local Recurrence and the Survival of Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection in Rectal Cancer.: Choi, Byung Gwan , Kim, Hyung Soo , Seo, Kyeong Won , Ju, Jae Kyoon , Ryu, Seong Yeob , Park, Young Kyu , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2007;23(1):46-52.; DOI: https://doi.org/10.3393/jksc.2007.23.1.46

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Abstract PDF: PURPOSE
One of the most common sites of recurrence after a curative resection of rectal cancer is the pelvis, and local control is a major goal of surgical treatment. The advantages of lateral pelvic lymph node dissection are regarded as questionable because lateral pelvic lymph node metastasis does not occur so frequently and because a lateral lymphadenectomy has a negative influence on the postoperative quality of life. The aim of this study was to clarify if lateral pelvic lymph node dissection (LPLD) conferred any benefit.
METHODS
A total of 769 patients who underwent curative surgery for rectal cancer between 1981 and 2005 at the Department of Surgery, OOO Hospital, were reviewed retrospectively. One hundred ninety-three of these patients underwent a lateral pelvic lymph node dissection, and 576 patients had a total mesorectal excision with high ligation of the IMA.
RESULTS
There was no difference in pathological characteristics between the two groups. Patients who underwent a lateral pelvic lymph node dissection had no statistically significant difference in terms of the 5-year survival rate at stage II and III (64% vs 65% at stage II, P=0.391; 49% vs 47% at stage III, P=0.815).
CONCLUSIONS
A lateral pelvic lymph node dissection has no advantage as part of a standard operation for rectal cancer. A total mesorectal excision alone has good local control and survival compared with a lateral pelvic lymph node dissection.

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