Lateral Pelvic Lymph Node Dissection for low locally advanced rectal cancer: a review

Document Type : Mini Review

Authors

1 Royal Prince Alfred Hospital, Sydney, Australia

2 Department of Colorectal Surgery, Royal Prince Alfred Hospital

3 Seoul St Mary’s Hospital, Catholic Medical Center, Seoul, South Korea

4 Chris O’Brien Lifehouse, Sydney, Australia

Abstract

Lateral pelvic lymph node dissection for advanced low rectal cancer has generated much discussion in the literature in last few years. Whilst it is still being debated as to whether it constitutes a locoregional disease amenable to surgery, or whether it is a distant metastases requiring neoadjuvant therapy, what is clear is that patients with enlarged lateral pelvic lymph nodes have higher rate of recurrence. In this review, we have analysed the current evidence and recommendations for lateral pelvic lymph node dissection. If advanced low rectal cancer (stage II, stage III) below peritoneal reflection, the decision to perform LPLND depends on (1) size of LPLN on MRI (>5mm) prior to neoadjuvant chemoradiotherapy and (2) non-responsive LPLN after CRT (LPLN >5mm before and after CRT). LPLN does prolong the operating time, and greater blood loss, however, is not associated with any greater morbidity. Preservation of the neurovascular structures, including the obturator nerves, hypogastric nerves, and the inferior vesical arteries must be identified and preserved. We have also described the key steps in performing lateral pelvic lymph node dissection.

Keywords

References

Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Disease of colon and rectum 2000; 43: 59-68.
Bell S, Sasaki J, Sinclair G, Chapuis P, Bokey E. Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues. Colorectal disease 2009; 11: 443-449.
Ueno H, Mochizuki H, Hashiguchi Y, Hase K. Prognostic determinants of patients with lateral noal involvement by rectal cancer. Annals of Surgery 2001; 234: 190-197.
Ueno H, Yamauchi C, Hase K, Ichikura T, Mochizuki H. Clinicopathological study of intrapelvic cancer spread to the iliac area in lower rectal adenocarcinoma by serial sectioning. British Journal of Surgery 1999; 86: 1532-1537.
Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Miyoshi M. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Annals of Surgery 2007;245: 80-87.
Shihab O, Taylor F, Bees N, Blake H. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. British Journal of Surgery 2011; 98: 1798-1804.
Heald R, Husband E, Ryall R. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? British Journal of Surgery 1982;69: 613-616.
Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T, Sugihara K. Results of a Japanese nationwide multi-institutional study on LPLN metastasis in low rectal cancer: is it regional or distant metastases? Annals of Surgery 2012; 255: 1129-1134.
Georgiou P, Tan E, Gouvas N, Antoniou A, Brown G, Nicholls R, Tekkis P. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncology 2009; 10: 1053-1062.
Kuster M, Beets G, Van de Valde C. A comparison betwen the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Annals of Surgery 2009; 249: 229-235.
Ogura A, Konishi T, Cunningham C, Garcia-Aguilar J, Iversen H, Toda S, et al. Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral node study of patients with low cT3/4 rectal cancer. Journal of Clinical Oncology 2019; 37: 33-43.
Kim T, Park W, Choi D, Park H, Kim S, Cho Y, et al. Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. International journal of colorectal disease 2014; 29: 193-200.
Kim M, Kim T, Kim D, Kim S, Baek J, Chang H, et al. Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? Journal of Surgical Oncology 2015; 111: 459-464.
Kim T, Jeong S, Choi D, Kim D, Jung K, Moon S, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Annals of surgical oncology 2008; 15: 729-737.
Kusters M, Slater A, Muirhead R, Hompes R, Guy R, Jones O, et al. What to do with lateral nodal disease in low locally advanced rectal cancer? a call for further reflection and research. Disease of colon and rectum 2017; 60: 577-585.
Ogawa S, Hida J, Ike H, Kinugasa T, Ota M, Shinto E, et al. Selection of lymph node-positive cases based on perirectal and LPLNs using magnetic resonance imaging: study of the Japanese society for cancer of the colon and rectum. Annals of surgical oncology 2016; 23: 1187-1194.
Ogawa S, Hida J, Ike H, Shinto E, Itabashi M, Okamoto T, et al. The important risk factor for LPLN metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum. International Journal of colorectal disease 2016; 31: 1719-1728.
Lee D, Matsuda T, Yamashita K, Hasegawa H, Yamamoto M, Kanaji S, et al. Significance of LPLN Size in Predicting Metastasis and Prognosis in Rectal Cancer. Anticancer research 2019; 39: 993-998.
Akiyoshi T, Matsueda K, Hiratsuka M, Unno T, Nagasaki T, Konishi T, et al. Indications for LPLN Dissection Based on Magnetic Resonance Imaging Before and After Preoperative Chemoradiotherapy in Patients with Advanced Low-Rectal Cancer. Annals of surgical oncology 2015; suppl 3: 614-620.
Kim M, Park SC, Kim T, Kim D, Kim S, Baek J, et al. Is lateral pelvic node dissection necessary after preoperative chemoradiotherapy for rectalcancer patients with initially suspected lateral pelvic node? Surgery 2016; 160: 366-376.
Oh H, Kang S, Lee S, Lee S, Ihn M, Kim D, et al. Neoadjuvant chemoradiotherapy affects the indications for lateral pelvic node dissection in mid/low rectal cancer with clinically suspected lateral node involvement: a multicenter retrospective cohort study. Annals of surgical oncology 2014; 21: 2280-2287.
Fujita S, Mizusawa J, Kinugasa Y, Komori K, Ohue M, Ota M, et al. Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212): A Multicenter, Randomized Controlled, Noninferiority Trial. Annals of Surgery 2017; 266: 201-207.
Komori K, Fujita S, Mizusawa J, Kanemitsu Y, Ito M. Predictive factors of pathological LPLN metastasis in patients without clinical LPLN metastasis (clinical stage II/III): The analysis of data from the clinical trial (JCOG0212). European journal of surgical oncology 2019; 45: 336-340.
Fujita S, Akasu T, Mizusawa J, Kinugasa Y. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomized controlled, non-inferiority trial. Lancet oncology 2012; 13: 616-621.
Moriya Y, Hojo K, Sawada T, Koyama Y. Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflections. Disease of colon and rectum 1989; 32: 307-315.
Kim M, Oh J. Lateral lymph node dissection with the focus on indications, functional outcomes, and minimally invasive surgery. Annals of Coloproctology 2018; 34: 229-223.
Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y, et al. Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. European Journal of surgical oncology 2016; 42: 1851-1858.
Manabe T, Koga Y, Kubo H, Baba K, Nagayoshi K, Nagai S. Adverse effects on the post-operative urinary function after combined resection of inferior vesical artery in laparoscopic LPLN dissection: retrospective analysis of consecutive 95 series. Surgical laparoscopy, endoscopy & percutaneous techniques 2019; Epub ahead of print. doi: 10.1097/SLE.0000000000000681
Iranian Journal of Colorectal Research
Volume 8, Issue 2
June 2020
Pages 65-74

Files

Share

How to cite

Statistics