Lateral Pelvic Lymph Node Dissection in Treatment of Advanced Rectal Cancer

Rectal cancer constitutes about one third of all colorectal cancer cases. Total mesorectal excision (TME), first described by Heald, has become the gold standard in rectal cancer treatment, since it was shown to provide a dramatic reduction in local recurrence rates. However, TME does not involve any approaches for lateral pelvic lymph nodes (LPLN), which may be a source of local recurrences. Tumor containing LPLNs were reported to be found in about 10% 20% of the rectal cancer patients. In Western countries, lateral pelvic node involvement is considered as metastatic disease, therefore the standard treatment is total mesorectal excision combined with neoadjuvant chemoradiotherapy. Whereas in Japan, lateral pelvic node metastasis is accepted to be curable with excision, and dissection of lateral pelvic lymph nodes is performed along with total mesorectal excision for the treatment of locally advanced rectal cancers.