Current understanding and management of positive lateral lymph nodes in rectal cancer patients
Main Article Content
Abstract
In the context of minimizing local recurrence rates after surgical treatment of rectal cancer, the issue of lateral pelvic lymph node (LPLN) dissection has remained as a controversial issue between West and East surgeons. The aim of the present paper was to review the incidence of lateral nodes, the associated risk factors and all the controversies regarding their management. While in Japan a prophylactic LPLN removal with autonomic nerve preservation (without neoadjuvancy) is considered the standard management of extra-peritoneal advanced rectal cancers, Western patients are usually treated with preoperative chemoradiotherapy (CRT) followed by total mesorectal excision. This choice is based on the effective reduction of local recurrences induced by CRT, culminating with similar outcomes when compared with LPN dissection. On the other side, this procedure is currently performed in Japan where LPN involvement is considered regional disease, so LPLN dissection is considered essential to improve outcomes. There exist suggestions that a selective approach to lateral nodes could be safely adopted in patients exhibiting radiological response after neoadjuvancy. However, others think that a more extended procedure is necessary even after CRT. Thus, the source and the risks of local recurrence must be individually assessed, and further high quality investigations must be developed to evaluate the efficacy of LPLN dissection with or without CRT.
Keywords:
rectal cancer, chemoradiation, lateral pelvic nodes, survival
Article Details
How to Cite
CAMPOS, Fábio Guilherme et al.
Current understanding and management of positive lateral lymph nodes in rectal cancer patients.
Medical Research Archives, [S.l.], v. 8, n. 8, aug. 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2199>. Date accessed: 27 dec. 2024.
doi: https://doi.org/10.18103/mra.v8i8.2199.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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6. Villemin F, Huard P, Montagn’e M. Recherches anatomiques sur les lymphatiques du rectum et de l’anus: leur applications dans le traitement chirurgical du cancer. Rev Chir. 1925;63:39–80.
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11. Kim JC, Takahashi K, Yu CS, et al. Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg. 2007;246(5): 754–762.
12. Kusters M, Beets GL, vandeVelde CJ et al. A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg. 2009;249(2):229–235.
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14. Cheng H, Deng Z, Wang ZJ et al (2011) Lateral lymph node dissection with radical surgery versus single radical surgery for rectal cancer: a meta-analysis. Asian Pac J Cancer Prev 12:2517–2521.
15. Akiyoshi T, Watanabe T, Miyata S, Kotake K, Muto T and Sugihara K; Japanese Society for Cancer of the Colon and Rectum: 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 2012; 255: 1129-1134.
16. Watanabe T, Itabashi M, Shimada Y et al. Japanese society for cancer of the colon and rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 2015; 20:207–239
17. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Murata K, Akagi Y, Takiguchi N, Saida Y, Nakamura K, Fukuda H, Akasu T, Moriya Y; Colorectal Cancer Study Group of Japan Clinical Oncology Group. Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212): A Multicenter, Randomized Controlled, Noninferiority Trial. Ann Surg. 2017; 266(2):201-207.
18. Sugihara K, Kobayashi H, Kato T, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006; 49:1663–1672.
19. Kobayashi H, Mochizuki H, Kato T, et al. Outcomes of surgery alone for lower rectal cancer with and without pelvic sidewall dissection. Dis Colon Rectum. 2009;52:567–576.
20. Ozawa H, Kotake K, Hosaka M, Hirata A, Sigihara K. Impact of Lateral Pelvic Lymph Node Dissection on the Survival of Patients with T3 and T4 Low Rectal Cancer. World J Surg. 2016;40(6):1492-9.
21. Watanabe T, Tsurita G, Muto T, Sawada T, Sunouchi K, Higuchi Y, Komuro Y, Kanazawa T, Iijima T, Miyaki M and Nagawa H: Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery 2002; 132: 27-33.
22. Ishihara S, Watanabe T, fukushima Y, et al. safety and factors contributing to the dificulty of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. Tech Coloproctol. 2014;18:247–255.
23. Ishihara S, Kanemitsu Y, Murono K, Otani K, Koji Y, Nishikawa T, Tanaka T, Tanaka J, Kiyomatsu T, Kawai K, Hata K, Nozawa H, Kazama S, Yamaguchi H, Sunami E, Sugihara K, Watanabe T. Oncological benefit of lateral pelvic lymph node dissection for rectal cancer treated without preoperative chemoradiotherapy: a multicenter retrospective study using propensity score analysis. Int J Colorectal Dis 2016; 31:1315–1321.
24. Ishihara S, Kawai K, tanaka T, Kiyomatsu T, Hata K, Nozawa H, Morikawa T, Watanabe T. Oncological Outcomes of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated With Preoperative Chemoradiotherapy . Dis Colon Rectum 2017; 60: 469–476.
25. Nagayoshi K, Ueki T, Manabe T, Moriyama T, Yanai K, Oda Y, Tanaka M. Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach. Surg Endosc 2015; 30 (5): 1938-47.
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27. Fujita S. Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis. Int J Colorectal Dis. 2014 ; 29(9):1077-80.
28. Kim MJ, Kim TH, Kim DY, et al. Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer? J Surg Oncol. 2015;111:459–464.
29. Kusters M, Slater A, Muirhead R, Hompes R, Guy RJ, Jones OM, George BD, Lindsey I, Mortensen NJ, Cunningham C. What To Do With Lateral Nodal Disease in Low Locally Advanced Rectal Cancer? A Call for Further Reflection and Research. Dis Colon Rectum. 2017 ; 60(6):577-585.
30. Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Levy MJ. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc. 2011;74(4):897-905
31. Shihab OC, Taylor F, Bees N, Blake H, Jeyadevan N, Bleehen R, Blomqvist L, Creagh M, George C, Guthrie A, Massouh H, Peppercorn D, Moran BJ, Heald RJ, Quirke P, Tekkis P, Brown G. MERCURY Study Group. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011 ;98(12):1798-804.
32. Kobayashi H, Kikuchi A, Okazaki S, et al. Diagnostic performance of multidetector row computed tomography for assessment of lymph node metastasis in patients with distal rectal cancer. Ann Surg Oncol. 2015;22:203–208.
33. Ishibe A, Ota M, Watanabe J, et al. Prediction of lateral pelvic lymph-node metastasis in low rectal cancer by magnetic resonance imaging. World J Surg. 2016;40:995–1001.
34. Ogawa S, Hida JI, Ike H, Kinugasa T, Ota M, Shinto E, Itabashi M, Okamoto T, Yamamoto M, Sugihara K, Watanabe T. Prediction of lateral pelvic lymph node metastasis from lower rectal cancer using magnetic resonance imaging and risk factors for metastasis: Multicenter study of the Lymph Node Committee of the Japanese Society for Cancer of the Colon and Rectum. Int J Colorectal Dis. 2017 Oct;32(10):1479-1487.
35. Shihab OC, Taylor F, Bees N et al. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98:1798–1804.
36. Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–596.
37. Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Unno T, Kano A, Kuroyanagi H, et al: 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, 2014.
38. Matsumoto T, Ohue M, Sekimoto M, Yamamoto H, Ikeda M, Monden M. Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases. Br J Surg. 2005 ;92(11):1444-8..
39. Coy CS, Meirelles LR, Leal RF et al. Evaluation of lateral lymph node metastases in advanced distal rectal cancer. Hepatogastroenterology 2010; 57:1363–1366
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