Is there a Role of Lateral Pelvic Lymph Node Dissection in the Current Era of Neoadjuvant Chemoradiotherapy for Rectal Cancer?

Abstract

Colorectal cancer is the third most common cancer in men. Total mesorectal excision remains the gold standard treatment for rectal cancer with chemoradiotherapy preceding the surgery in all locally advanced rectal malignancies. Lateral pelvic lymph node dissection (LPLND), although a part of standard surgery for rectal cancers treatment in Japan has not been adopted by surgeons in the rest of the world. There is a long-standing controversy on whether lateral pelvic node metastasis represents localized or metastatic disease. Current standard in Japan is to consider lateral pelvic nodes as regional disease and, hence, perform prophylactic LPLND in low rectal cancers of stage T3 or more or with involved mesorectal nodes. In contrast, standard therapy in west is to consider lateral pelvic nodes as systemic disease and, hence, to either ignore them or treat obvious nodes with chemoradiotherapy. In Japan, neoadjuvant chemoradiotherapy (NACTRT) is less commonly used for locally advanced rectal cancers in contrast to the practice in the west. The role of LPLND in patients receiving NACTRT remains to be established. The aim of this article is to review the evidence for the role of LPLND in the current era of NACTRT.