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The role of lateral lymph node dissection in the management of lower rectal cancer

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Abstract

Introduction

Lateral lymph node involvement is a problem encountered in patients with low rectal cancers. This has been documented in both anatomical and pathological studies. Currently, the vast majority of centers have concentrated on the use of chemoradiation to obtain better local control and manage these nodes indirectly. In Japan, extended nodal dissection for the control of pelvic nodal disease has seen further advancement. This paper discusses the key issues involved in the management of pelvic lateral nodes in low rectal cancers.

Methods

A review of available literature and critical appraisal of the entity of lateral nodes in low rectal cancers, the treatment options, and oncological and functional results were performed.

Results

There are good data showing that the entity of pelvic lateral nodes in low rectal cancers should not be ignored. Recent data have emerged showing that radiotherapy is associated with significant long-term functional side effects. Refinement of the technique, lateral node dissection, has led to good local control as well as good functional outcomes.

Conclusion

In this context, there needs to be a reevaluation of the role of chemoradiation as the sole treatment for lateral nodal disease in centers outside of Japan. Individualization of the treatment of rectal cancer may require all centers to be able to offer both modalities.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Ziting Wang

  2. School of Pharmacy, University of London, London, UK

    Kep Yong Loh

  3. Department of Surgery, Colorectal Service, Alexandra Health, Khoo Teck Puat Hospital, Yishun, Singapore

    Ziting Wang, Kep Yong Loh, Kok-Yang Tan & Emile Chung-Hou Woo

  4. Department of Surgery, Mt. St. Joseph Hospital, The University of British Columbia, Vancouver, BC, Canada

    Emile Chung-Hou Woo

  5. Department of Surgery, Alexandra Health, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore

    Kok-Yang Tan

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  1. Ziting Wang
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  2. Kep Yong Loh
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Correspondence to Kok-Yang Tan.

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Wang, Z., Loh, K.Y., Tan, KY. et al. The role of lateral lymph node dissection in the management of lower rectal cancer. Langenbecks Arch Surg 397, 353–361 (2012). https://doi.org/10.1007/s00423-011-0864-x

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  • DOI: https://doi.org/10.1007/s00423-011-0864-x

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