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The Landmark Series: Management of Lateral Lymph Nodes in Locally Advanced Rectal Cancer


There has historically been a significant divide in the approach to the management of lateral pelvic lymph nodes in patients with rectal cancer. These differing paradigms have developed based upon competing priorities. In the West, the circumferential resection margin has been the main focus because it is a strong predictor of local recurrence, distal recurrence, and survival. This approach was supplemented by radiation and chemotherapy to treat the lateral pelvic lymph nodes and micrometastatic disease. In the East, lateral pelvic lymph nodes are considered to be locoregional; thus, surgical treatment has traditionally included routine dissection of this compartment for low rectal cancers without the use of neoadjuvant chemoradiotherapy. However, neither approach has adequately addressed the important issue of lateral compartment recurrence in patients with clinically evident lateral pelvic lymph node metastasis. The aims of the review were to present the recent key studies and evolution of lateral pelvic lymph node management in locally advanced rectal cancer and secondly to propose a management strategy for the lateral compartment based on the current evidence.

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Fig. 1

Reproduced with permission from Fujita et al.16

Fig. 2

Reproduced with permission from Akiyoshi et al.22

Fig. 3

Reprinted from Kanemitsu et al.23

Fig. 4

Reprinted with permission from Ogura et al.11

Fig. 5

Reprinted with permission from Ogura et al.11

Fig. 6

Reproduced with permission from Malakorn et al.36


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Sources of support: This study was supported in part by the Aman Trust (GJC), the Andrews Family Fund (GJC), and National Institutes of Health/National Cancer Institute Grant CA016672 (The University of Texas MD Anderson Cancer Center Support Grant). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; and decision to submit for publication.

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Correspondence to George J. Chang MD, MS.

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Dr GJ Chang is a consultant for Medicaroid.

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Peacock, O., Chang, G.J. The Landmark Series: Management of Lateral Lymph Nodes in Locally Advanced Rectal Cancer. Ann Surg Oncol 27, 2723–2731 (2020).

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