Skip to main content

Advertisement

SpringerLink
Log in

Lateral lymph node dissection in advanced low rectal cancer treatment

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

A Correction to this article was published on 22 September 2021

This article has been updated

Abstract

Lateral lymph node (LLN) metastasis is a determinant of local recurrence in advanced low rectal cancer. Lateral lymph node dissection (LLND) is effective in removing metastatic lymph nodes, and has been shown to have a decreased local recurrence rate. However, because of its complexity and complications it induces, there is still tremendous controversy about its usage. Neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME) are recommended as a conventional treatment for advanced rectal cancer. However, LLN metastasis and local recurrence still occur despite nCRT with TME. In Japan, TME with LLND is the standard surgical treatment for Stage II/III of advanced low rectal cancer. Before surgery, a proper evaluation of LLN status should be performed. Laparoscopic LLND and robotic-assisted LLND are useful for this. More research is necessary to improve the oncological outcomes of LLND. In this review, we retrospectively examine previous reports about LLND, aiming to emphasize its application prospects to improve patient survival and life quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

The manuscript consists of availability data, including 3 figures (TIFF files) and 3 table (Word file).

Code availability

Our study did not require a software application.

Change history

References

  1. Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108. https://doi.org/10.3322/caac.21262

  2. Watanabe T, Muro K, Ajioka Y et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23:1–34. https://doi.org/10.1007/s10147-017-1101-6

  3. Chen W, Zheng R, Baade PD et al (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132. https://doi.org/10.3322/caac.21338

  4. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136: E359–386. https://doi.org/10.1002/ijc.29210

  5. Tjandra JJ, Kilkenny JW, Buie WD et al (2005) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 48:411–423. https://doi.org/10.1007/s10350-004-0937-9

  6. Kim TH, Jeong SY, Choi DH et al (2008) Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 15:729–37. https://doi.org/10.1245/s10434-007-9696-x

  7. Lee DJ, Sagar PM, Sadadcharam G et al (2017) Advances in surgical management for locally recurrent rectal cancer: How far have we come? World J Gastroenterol 23:4170–4180. https://doi.org/10.3748/wjg.v23.i23.4170

  8. Hu X (2018) Local anatomy and classification of the rectal lymphatic system. Chin J Pract Surg 38:1128–32. https://doi.org/10.19538/j.cjps.issn

  9. Delamere G, Poirier P, Cuneo B et al (1904) The lymphatics general anatomy of the lymphatics. W. T. Keener: Chicago

  10. Nakamura T, Watanabe M (2013) Lateral lymph node dissection for lower rectal cancer. World J Surg 37:1808–1813. https://doi.org/10.1007/s00268-013-2072-z

  11. Fujita S, Yamamoto S, Akasu T et al (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585. https://doi.org/10.1002/bjs.4350

  12. Ueno M, Oya M, Azekura K et al (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg 92:756–763. https://doi.org/10.1002/bjs.4975

  13. Sugihara K, Kobayashi H, Kato T et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49:1663–1672. https://doi.org/10.1007/s10350-006-0714-z

  14. Fujita S, Yamamoto S, Akasu T et al (2009) Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis 24:1085–1090. https://doi.org/10.1007/s00384-009-0704-4.

  15. Ueno H, Mochizuki H, Hashiguchi Y et al (2007) Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg 245:80–87. https://doi.org/10.1097/01.sla.0000225359.72553.8c

  16. Sauer I, Bacon HE (1952) A new approach for excision of carcinoma of the lower portion of the rectum and anal canal. Surg Gynecol Obstet 95:229–242

    CAS  PubMed  Google Scholar 

  17. Stearns MW Jr, Deddish MR (1959) Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 2:169–172. https://doi.org/10.1007/BF02616711

  18. Glass RE, Ritchie JK, Thompson HR et al (1985) The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy. Br J Surg 72:599–601. https://doi.org/10.1002/bjs.1800720805

  19. Michelassi F, Block GE (1992) Morbidity and mortality of wide pelvic lymphadenectomy for rectal adenocarcinoma. Dis Colon Rectum; 35:1143–1147. https://doi.org/10.1007/BF02251965

  20. Heald RJ, Husband EM, Ryall RD et al (1982) The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg 69:613–616. https://doi.org/10.1002/bjs.1800691019

  21. Martling AL, Holm T, Rutqvist LE et al (2000) Effect of a surgical training program on outcome of rectal cancer in the county of Stockholm. Lancet 356:93–96. https://doi.org/10.1016/s0140-6736(00)02469-7

  22. Kapiteijn E, Corrie AM, Marijnen MD et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646. https://doi.org/10.1056/NEJMoa010580

  23. Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial. Long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650. https://doi.org/10.1200/JCO.2005.08.144

  24. Gérard JP, Conroy T, Bonnetaion F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers; resulting of FFCD 9203. J Clin Oncol 24:4620–4625. https://doi.org/10.1200/JCO.2006.06.7629

  25. Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123. https://doi.org/10.1056/NEJMoa060829

  26. Jeyarajah S, Sutton CD, Miller AS et al (2007) Factors that influence the adequacy of total medorectal excision for rectal cancer. Colorectal Dis 9:808–815. https://doi.org/10.1111/j.1463-1318.2007.01256.x

  27. Hansen MH, Kjaeve J, Revhaug A et al (2007) Impact of radiotherapy on local recurrence of rectal cancer in Norway. Br J Surg 94:113–118. https://doi.org/10.1002/bjs.5576

  28. Påhlman L, Bohe M, Cedermark B et al (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292. https://doi.org/10.1002/bjs.5679

  29. Kusters M, Beets GL, van de Velde CJ et al (2009) A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg 249:229–235. https://doi.org/10.1097/SLA.0b013e318190a664

  30. Kusters M, Marijnen CA, van de Velde CJ et al (2010) Patterns of local recurrence in rectal cancer: a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476. https://doi.org/10.1016/j.ejso.2009.11.011.

  31. Yu S, Mamtani R, O'Hara MH et al (2021) Comparative effectiveness of total neoadjuvant therapy versus standard adjuvant chemotherapy for locally advanced rectal cancer. Clin Colorectal Cancer 22:S1533–0028(21)00002–5. https://doi.org/10.1016/j.clcc.2021.01.001.

  32. López-Campos F, Martín-Martín M, Fornell-Pérez R et al (2020) Watch and wait approach in rectal cancer: current controversies and future directions. World J Gastroenterol 26:4218–4239. https://doi.org/10.3748/wjg.v26.i29.4218.

  33. Kusters M, Slater A, Muirhead R et al (2017) What to do with lateral nodal disease in low locally advanced rectal cancer? A call for further reflection and research. Dis Colon Rectum 60:577–585. https://doi.org/10.1097/DCR.0000000000000834

  34. Ogura A, Konishi T, Cunningham C et al (2019) 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. J Clin Oncol 37:33–43. https://doi.org/10.1200/JCO.18.00032

  35. Kim TG, Park W, Chio DH et al (2014) Factors associated with lateral pelvic recurrence after curative resection following neoadjuvant chemoradiotherapy in rectal cancer patients. Int J Colorectal Dis.; 29:193–200. https://doi.org/10.1007/s00384-013-1797-3

  36. Kim MJ, Kim TH, Kim DY et al (2015) Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol 111(4):459–464. https://doi.org/10.1002/jso.23852

    Article  PubMed  Google Scholar 

  37. Hojo K, Koyama Y (1982) Postoperative follow-up studies on cancer of the colon and rectum. Am J Surg 143:293–293. https://doi.org/10.1016/0002-9610(82)90093-9

  38. Hojo K, Sawada T, Moriya Y (1989) An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy. Dis Colon Rectum 32:128–133. https://doi.org/10.1007/BF02553825

  39. Moriya Y, Sugihara K, Akasu T et al (1995) Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer 31A:1229–1232. https://doi.org/10.1016/0959-8049(95)00164-e

  40. Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg 383:409–415. https://doi.org/10.1007/s004230050153

  41. Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer Is it regional or distant disease? Ann Surg 255:1129–1134. https://doi.org/10.1097/SLA.0b013e3182565d9d

  42. Moriya Y, Sugihara K, Akasu T et al (1997) Importance of extended lymphadenectomy with lateral nide dissection for advanced lower rectal cancer. World J Surg 21:728–732. https://doi.org/10.1007/s002689900298

  43. Takahashi T, Ueno M, Azekura K et al (2000) Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum 43:S59–68. https://doi.org/10.1007/BF02237228

  44. Kobayashi H, Mochizuki H, Kato T et al (2009) Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum 52:567–576. https://doi.org/10.1007/DCR.0b013e3181a1d994

  45. Tamura H, Shimada Y, Kameyama H et al (2017) Prophylactic lateral pelvic lymph node dissection in stage IV low rectal cancer. World J Clin Oncol 8:412–419. https://doi.org/10.5306/wjco.v8.i5.412

  46. Komori K, Fujita S, Mizusawa J et al (2019) Predictive factors of pathological lateral pelvic lymph node metastasis in patients without clinical lateral pelvic lymph node metastasis (clinical stage II/III): The analysis of data from the clinical trial (JCOG0212). Eur J Surg Oncol 45:336–340. https://doi.org/10.1016/j.ejso.2018.11.016

  47. Fujita S, Mizusawa J, Kanemitsu Y et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212). Ann Surg 266:201–207. https://doi.org/10.1097/SLA.0000000000002212

  48. Kim JC, Takahashi K, Yu CS et al (2007) Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 246:754–762. https://doi.org/10.1097/SLA.0b013e318070d587

  49. Akiyoshi T, Ueno M, Matsueda K et al (2014) Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol 21:189–196. https://doi.org/10.1245/s10434-013-3216-y

  50. Ishihara S, Kawai K, Tanaka T et al (2017) Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy. Dis Colon Rectum 60:469–476. https://doi.org/10.1097/DCR.0000000000000752

  51. Al-sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19: 2212–2223. https://doi.org/10.1245/s10434-011-2210-5

  52. Ishibe A, Ota M, Watanabe J et al (2016) Prediction of lateral pelvic lymph-node metastasis in lower rectal cancer by magnetic resonance imaging. World J Surg 40:995–1001. https://doi.org/10.1007/s00268-015-3299-7

  53. Lim SB, Yu CS, Kim CW et al (2013) Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Int J Colorectal Dis 28:1667–1674. https://doi.org/10.1007/s00384-013-1761-2

  54. Akiyoshi T, Matsuda K, Hiratsuka M et al (2015) Indications for lateral pelvic lymph node dissection based on magnetic resonance imaging before and after preoperative chemoradiotherapy in patients with advanced low-rectal cancer. Ann Surg Oncol 22: S614–620. https://doi.org/10.1245/s10434-015-4565-5

  55. Oh HK, Kang SB, Lee SM et al (2014) 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. Ann Surg Oncol 21:2280–2287. https://doi.org/10.1245/s10434-014-3559-z

  56. Matsuda T, Sumi Y, Yamashita K et al (2018) Outcomes and prognostic factors of selective lateral pelvic lymph node dissection with preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Colorectal Dis 33:367–374. https://doi.org/10.1007/s00384-018-2974-1

  57. Brown G, Richards CJ, Bourne MW et al (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377. https://doi.org/10.1148/radiol.2272011747

  58. Ye Y, Liu T, Lu L et al (2015) Pro-operative TNM staging of primary colorectal cancer by (18)F-FDG PET-CT or PET: A meta-analysis including 2283 patients. Int J Clin Exp Med 8:21773–21785. https://eCollection 2015

  59. Mizukami Y, Ueda S, Mizumoto A et al (2011) Diffusion-weighted magnetic resonance imaging for detecting lymph node metastasis of rectal cancer. World J Surg 35:895–899. https://doi.org/10.1007/s00268-011-0986-x

  60. Hojo K, Vernava AM, Sugihara K et al (1991) Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum 34:532–539. https://doi.org/10.1007/BF02049890

  61. Fujita S, Akasu T, Mizusawa J et al (2012) 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 multicenter, randomized controlled, non-inferiority trial. Lancet Oncol 13:616–621. https://doi.org/10.1016/S1470-2045(12)70158-4

  62. Abulafi AM, Williams NS (1994) Local recurrence of colorectal cancer: the problem, mechanisms, management, and adjuvant therapy. Br J Surg 81:7–19. https://doi.org/10.1002/bjs.1800810106

  63. Yamaguchi T, Konishi T, Kinugasa Y et al (2017) Laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer: a subgroup analysis of a large multicenter cohort study in Japan. Dis Colon Rectum 60:954–964. https://doi.org/10.1097/DCR.0000000000000843

  64. Yamaguchi T, Kinugasa Y, Shiomi A et al (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679–1685. https://doi.org/10.1007/s00464-014-3855-5

  65. Yamaguchi T, Kinugasa Y, Shiomi A et al (2016) Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc.; 30:721–728. https://doi.org/10.1007/s00464-015-4266-y

  66. Kagawa H, Kinugasa Y, Shiomi A et al (2015) Robotic-assisted lateral lymph node dissection for lower rectal cancer: short-term outcomes in 50 consecutive patients. Surg Endosc 29:995–1000. https://doi.org/10.1007/s00464-014-3760-y

  67. Yamaguchi T, Kinugasa Y, Shiomi A et al (2018) Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer. Surg Endosc 32:4498–4505. https://doi.org/10.1007/s00464-018-6197-x.

  68. Hashiguchi Y, Muro K, Saito Y et al (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42. https://doi.org/10.1007/s10147-019-01485-z.

  69. Yokoyama S, Takifuji K, Hotta T et al (2014) Survival benefit of lateral lymph node dissection according to the region of involvement and the number of lateral lymph nodes involved. Surg Today 44:1097–1103. https://doi.org/10.1007/s00595-013-0815-y

Download references

Acknowledgements

We thank Dr N. Hou for her clerical support.

Funding

This work was supported by the grant from the Shaanxi Province Key Research and Development Plan (2021KW-59) to Jie Li.

Author information

Authors and Affiliations

  1. Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, West 5 Road, Xi’an, 710004, China

    Jie Li

  2. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Akio Shiomi

Authors
  1. Jie Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akio Shiomi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conception, writing, and critically reviewing the content of the article. All authors approved the final version for submission.

Corresponding author

Correspondence to Akio Shiomi.

Ethics declarations

Ethics approval

Our study did not require an ethical board approval because it did not contain human or animal trials.

Consent to participate

All authors participated the writing of this manuscript.

Consent for publication

All authors approved publication in International Journal of Colorectal Diseases.

Conflict of interest

The authors declare that there is no conflict of interest.

Additional information

The original online version of this article was revised: The figure legend of Figure 1 was changed to clarify its originality

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, J., Shiomi, A. Lateral lymph node dissection in advanced low rectal cancer treatment. Int J Colorectal Dis 36, 2361–2371 (2021). https://doi.org/10.1007/s00384-021-03975-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-021-03975-x

Keywords

Search

Navigation