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Clin Colon Rectal Surg 2017; 30(05): 346-356
DOI: 10.1055/s-0037-1606112
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is There Any Reason to Still Consider Lateral Lymph Node Dissection in Rectal Cancer? Rationale and Technique

Miranda Kusters
1   Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
2   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Keisuke Uehara
3   Division of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Cornelis J. H. van de Velde
2   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Yoshihiro Moriya
4   Department of Colorectal Surgery, Miki Hospital, Iwate, Japan
› Author Affiliations
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Publication History

Publication Date:
27 November 2017 (online)

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Abstract

Nodal dissemination in locally advanced rectal cancer occurs mainly in two directions: upward and lateral. Lateral node involvement has been demonstrated; however, lateral lymph node dissection (LLND) is not routinely performed in Western countries and the focus is more on neoadjuvant treatment regimens. The main reasons for this are the high morbidity associated with the operation and the uncertain oncological benefit. There is, however, recent evidence that in selected cases, neoadjuvant treatment combined with total mesorectal excision only might not be sufficient. In this article, the historical developments in the East and the West, the current evidence regarding lateral nodal disease, and the surgical steps in the LLND are discussed.

Keywords

rectal cancer - lateral nodes - local recurrence
 

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