Abstract
The importance of total mesorectal excision (TME) has been the global standard of
care in patients with rectal cancer. However, there is no universal strategy for lateral
lymph nodes (LLN). The treatment of the lateral compartment remains controversial
and has gone to the opposite directions between Eastern and Western countries in the
past decades. In the East, mainly Japan, surgeons consider LLN metastases as regional
disease and have performed TME with lateral lymph node dissection (LLND) without neoadjuvant
(chemo)radiotherapy ([C]RT) in patients with clinical Stage II/III rectal cancer below
the peritoneal reflection. In the West, neoadjuvant radiotherapy or has been the standard,
and surgeons do not perform LLND assuming the (C)RT can sterilize most lateral lymph
node metastasis (LLNM). Recent evidences show that lateral nodes are the major cause
of local recurrence after (C)RT plus TME, and LLND reduces local recurrence particularly
from the lateral compartment. Probably a combination of the two strategies, that is,
neoadjuvant (C)RT plus LLND, would be needed to improve outcomes in patients with
lateral nodal disease.
Keywords
rectal cancer - lateral lymph node - lateral lymph node dissection - radiotherapy
- chemoradiotherapy